10D1080868 CLIA NUMBER - BROOKDALE ST AUGUSTINE

Laboratory Demographics

  • CLIA Code: 10D1080868
  • Facility Name: BROOKDALE ST AUGUSTINE
  • Facility Address: 150 MARINER HEALTH WAY
    SAINT AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 904 794-9988
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: CHAD ANSINSON
  • NPI Number: 1902132749
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D1080868
LAB Type Assisted Living Facility
Facility Name BROOKDALE ST AUGUSTINE
Street 150 MARINER HEALTH WAY
City SAINT AUGUSTINE
State FL
ZIP 32086
Phone 904 794-9988
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2024
Certificate Expiration Date 3/3/2026
Facility Type Assisted Living Facility
Lab Director CHAD ANSINSON

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