10D0879772 CLIA NUMBER - EMORY L BENNETT MEM VET NURSING HOME

Laboratory Demographics

  • CLIA Code: 10D0879772
  • Facility Name: EMORY L BENNETT MEM VET NURSING HOME
  • Facility Address: 1920 MASON AVENUE
    DAYTONA BEACH, FL
    ZIP 32117
  • Facility Phone: 386 274-3460
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: COLLEEN SULLIVAN
  • NPI Number: 1043439292
  • Taxonomy: 332100000X - Department of Veterans Affairs (VA) Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D0879772
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name EMORY L BENNETT MEM VET NURSING HOME
Street 1920 MASON AVENUE
City DAYTONA BEACH
State FL
ZIP 32117
Phone 386 274-3460
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2023
Certificate Expiration Date 12/1/2025
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director COLLEEN SULLIVAN

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