10D1047930 CLIA NUMBER - WESLEY HAVEN VILLA

Laboratory Demographics

CLIA Number: 10D1047930

Facility Name: WESLEY HAVEN VILLA

Facility Address:
111 EAST WRIGHT ST
PENSACOLA, FL
ZIP 32501
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Facility Phone Number: 850 434-1035

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1750430344

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	10D1047930
LAB Type	Assisted Living Facility
Facility Name	WESLEY HAVEN VILLA
Street	111 EAST WRIGHT ST
City	PENSACOLA
State	FL
ZIP	32501
Phone	850 434-1035
CertificateType	4
CertificateEffectiveDate	11/17/2023
CertificateExpirationDate	11/16/2025
FacilityType	Waiver

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