10D0894594 CLIA NUMBER - ST JOHNS COUNTY FIRE RESCUE

Laboratory Demographics

CLIA Code: 10D0894594
Facility Name: ST JOHNS COUNTY FIRE RESCUE
Facility Address: 3657 GAINES ROAD
SAINT AUGUSTINE, FL
ZIP 32084
Facility Phone: 904 823-2640
Facility Type: Mobile Laboratory
Facility Type: Waiver
Lab Director: KERRY BACHISTA
NPI Number: 1265751762
Taxonomy: 322D00000X - Residential Treatment Facility, Emotionally Disturbed Children

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CLIA Record

Field Name	Field Value
CLIA Number	10D0894594
LAB Type	Mobile Laboratory
Facility Name	ST JOHNS COUNTY FIRE RESCUE
Street	3657 GAINES ROAD
City	SAINT AUGUSTINE
State	FL
ZIP	32084
Phone	904 823-2640
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	11/17/2024
Certificate Expiration Date	11/16/2026
Facility Type	Mobile Laboratory
Lab Director	KERRY BACHISTA

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