10D0986908 CLIA NUMBER - PALM COTTAGE OPERATOR LLC

Laboratory Demographics

CLIA Number: 10D0986908

Facility Name: PALM COTTAGE OPERATOR LLC

Facility Address:
3821 SUNNYSIDE CT
ROCKLEDGE, FL
ZIP 32955
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Facility Phone Number: 321 633-1819

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1255699468

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	10D0986908
LAB Type	Other
Facility Name	PALM COTTAGE OPERATOR LLC
Street	3821 SUNNYSIDE CT
City	ROCKLEDGE
State	FL
ZIP	32955
Phone	321 633-1819
CertificateType	4
CertificateEffectiveDate	5/24/2023
CertificateExpirationDate	5/23/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024