10D1045395 CLIA NUMBER - PONDELLA SERENITY COURT LLC

Laboratory Demographics

CLIA Number: 10D1045395

Facility Name: PONDELLA SERENITY COURT LLC

Facility Address:
1923 NE 6TH ST
CAPE CORAL, FL
ZIP 33909
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Facility Phone Number: 239 242-0597

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1487123733

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	10D1045395
LAB Type	Other
Facility Name	PONDELLA SERENITY COURT LLC
Street	1923 NE 6TH ST
City	CAPE CORAL
State	FL
ZIP	33909
Phone	239 242-0597
CertificateType	4
CertificateEffectiveDate	9/14/2023
CertificateExpirationDate	9/13/2025
FacilityType	Waiver

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