10D0955284 CLIA NUMBER - LADY LAKE SPECIALTY CARE CENTER AND REHAB LLC

Laboratory Demographics

  • CLIA Code: 10D0955284
  • Facility Name: LADY LAKE SPECIALTY CARE CENTER AND REHAB LLC
  • Facility Address: 630 GRIFFIN AVENUE
    LADY LAKE, FL
    ZIP 32159
  • Facility Phone: 352 750-6619
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: TONYA OLIVER
  • NPI Number: 1326043050
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D0955284
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LADY LAKE SPECIALTY CARE CENTER AND REHAB LLC
Street 630 GRIFFIN AVENUE
City LADY LAKE
State FL
ZIP 32159
Phone 352 750-6619
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2024
Certificate Expiration Date 12/22/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director TONYA OLIVER

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