05D2292541 CLIA NUMBER - BROOKDALE KETTLEMAN LANE

Laboratory Demographics

  • CLIA Code: 05D2292541
  • Facility Name: BROOKDALE KETTLEMAN LANE
  • Facility Address: 2150 WEST KETTLEMAN LANE
    LODI, CA
    ZIP 95242
  • Facility Phone: 209 333-8033
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JOHN M. GEISS
  • NPI Number: 1952639353
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2292541
LAB Type Assisted Living Facility
Facility Name BROOKDALE KETTLEMAN LANE
Street 2150 WEST KETTLEMAN LANE
City LODI
State CA
ZIP 95242
Phone 209 333-8033
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Assisted Living Facility
Lab Director JOHN M. GEISS

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