10D0719820 CLIA NUMBER - VISTA MANOR

Laboratory Demographics

  • CLIA Code: 10D0719820
  • Facility Name: VISTA MANOR
  • Facility Address: 1550 JESS PARRISH COURT
    TITUSVILLE, FL
    ZIP 32796
  • Facility Phone: 321 269-2200
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DEBRA A. WALLACE
  • NPI Number: 1396014171
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D0719820
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name VISTA MANOR
Street 1550 JESS PARRISH COURT
City TITUSVILLE
State FL
ZIP 32796
Phone 321 269-2200
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 DEBRA A. WALLACE

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