10D1035954 CLIA NUMBER - LHCG CLVII LLC DBA MEDERI CARETENDERS

Laboratory Demographics

CLIA Number: 10D1035954

Facility Name: LHCG CLVII LLC DBA MEDERI CARETENDERS

Facility Address:
2170 W STATE ROAD 434 SUITE 250
LONGWOOD, FL
ZIP 32779
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Facility Phone Number: 407 661-1963

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1568082402

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	10D1035954
LAB Type	Home Health Agency
Facility Name	LHCG CLVII LLC DBA MEDERI CARETENDERS
Street	2170 W STATE ROAD 434 SUITE 250
City	LONGWOOD
State	FL
ZIP	32779
Phone	407 661-1963
CertificateType	4
CertificateEffectiveDate	1/18/2023
CertificateExpirationDate	1/17/2025
FacilityType	Waiver

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