10D0726625 CLIA NUMBER - FLORIDA MENTOR II LLC

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CLIA Record

Field Name Field Value
CLIA Number 10D0726625
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name FLORIDA MENTOR II LLC
Street 1407 LINCOLN DR
City PANAMA CITY
State FL
ZIP 32401
Phone 850 769-7636
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 Intermediate Care Facility for Mentally Retarded
Lab Director KEITH BANTON

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