53D2200067 CLIA NUMBER - AMIE HOLT CARE CENTER

Laboratory Demographics

  • CLIA Code: 53D2200067
  • Facility Name: AMIE HOLT CARE CENTER
  • Facility Address: 497 W LOTT AVE
    BUFFALO, WY
    ZIP 82834
  • Facility Phone: 307 684-6161
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: BRENDA GORM
  • NPI Number: 1427037407
  • Taxonomy: 311ZA0620X - Custodial Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 53D2200067
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AMIE HOLT CARE CENTER
Street 497 W LOTT AVE
City BUFFALO
State WY
ZIP 82834
Phone 307 684-6161
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2024
Certificate Expiration Date 11/12/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director BRENDA GORM

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This page was last updated on: 9/29/2025