10D0947011 CLIA NUMBER - INDIGO PALMS

Laboratory Demographics

  • CLIA Code: 10D0947011
  • Facility Name: INDIGO PALMS
  • Facility Address: 570 NATIONAL HEALTHCARE DRIVE
    DAYTONA BEACH, FL
    ZIP 32114
  • Facility Phone: 386 238-3333
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: RANDOLPH E. KERNON II
  • NPI Number: 1376741124
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D0947011
LAB Type Other
Facility Name INDIGO PALMS
Street 570 NATIONAL HEALTHCARE DRIVE
City DAYTONA BEACH
State FL
ZIP 32114
Phone 386 238-3333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2024
Certificate Expiration Date 6/8/2026
Facility Type Other
Lab Director RANDOLPH E. KERNON II

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