51D1041260 CLIA NUMBER - MULLENS MANOR INC

Laboratory Demographics

CLIA Number: 51D1041260

Facility Name: MULLENS MANOR INC

Facility Address:
1238 A GUYANDOTTE AVENUE
MULLENS, WV
ZIP 25882
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Facility Phone Number: 304 732-8502

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1063562288

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	51D1041260
LAB Type	Assisted Living Facility
Facility Name	MULLENS MANOR INC
Street	1238 A GUYANDOTTE AVENUE
City	MULLENS
State	WV
ZIP	25882
Phone	304 732-8502
CertificateType	4
CertificateEffectiveDate	5/27/2023
CertificateExpirationDate	5/26/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024