DIANA'S BOARDING HOME 2 INC
NPI 1285227397
Community Based Residential Treatment Facility, Mental Illness in Marble Hill, MO
- Organization
- Community Based Residential Treatment Fa...
- CLIA Number: 26D2117368
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 08-15-2026
About DIANA'S BOARDING HOME 2 INC
This page provides the complete NPI Profile along with additional information for Diana's Boarding Home 2 Inc, a provider established in Marble Hill, Missouri operating as a Community Based Residential Treatment Facility, Mental Illness. The healthcare provider is registered in the NPI registry with number 1285227397 assigned on February 2021. The practitioner's primary taxonomy code is 320800000X. The provider is registered as an organization and their NPI record was last updated 5 years ago. The authorized official of this NPI record is Mr. Terry Dustin Wagner (Owner/president)
- NPI
- 1285227397 Verify this NPI
- Provider Name
- DIANA'S BOARDING HOME 2 INC
- Entity Type
- Organization
- Location Address
- 4677 STATE HWY M MARBLE HILL, MO 63764
- Location Phone
- (573) 238-3344
- Location Fax
- (573) 238-3361
- Mailing Address
- HC 64 BOX 4677 MARBLE HILL, MO 63764
- Mailing Phone
- (573) 238-3344
- Mailing Fax
- (573) 238-3361
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-19-2021
- Last Update Date
- 02-19-2021
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Community Based Residential Treatment Facility, Mental Illness
- Taxonomy Code
- 320800000X
- Type
- Residential Treatment Facilities
- Taxonomy Description
- A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 26D2117368
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- August 16, 2024
- Certificate Expiration Date
- August 15, 2026
- Laboratory Director
- ASHLEY C. WAGNER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Diana's Boarding Home 2 Inc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1285227397, enumerated as an "organization" on February 19, 2021.
The provider is located at 4677 STATE HWY M MARBLE HILL, MO 63764 and the phone number is (573) 238-3344.
Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.
