10D0712680 CLIA NUMBER - LAKE MONTGOMERY HEALTH AND REHABILITATION CENTER

Laboratory Demographics

  • CLIA Code: 10D0712680
  • Facility Name: LAKE MONTGOMERY HEALTH AND REHABILITATION CENTER
  • Facility Address: 1270 SW MAIN BLVD
    LAKE CITY, FL
    ZIP 32025
  • Facility Phone: 386 752-7900
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: BRIAN A. POLLETT
  • NPI Number: 1750365706
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D0712680
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LAKE MONTGOMERY HEALTH AND REHABILITATION CENTER
Street 1270 SW MAIN BLVD
City LAKE CITY
State FL
ZIP 32025
Phone 386 752-7900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director BRIAN A. POLLETT

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