10D1090612 CLIA NUMBER - WICKSHIRE PORT ST LUCIE OPCO LLC

Laboratory Demographics

  • CLIA Code: 10D1090612
  • Facility Name: WICKSHIRE PORT ST LUCIE OPCO LLC
  • Facility Address: 9825 S US HWY 1
    PORT SAINT LUCIE, FL
    ZIP 34952
  • Facility Phone: 772 337-0084
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MICHELLE RHOADES
  • NPI Number: 1184222002
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D1090612
LAB Type Assisted Living Facility
Facility Name WICKSHIRE PORT ST LUCIE OPCO LLC
Street 9825 S US HWY 1
City PORT SAINT LUCIE
State FL
ZIP 34952
Phone 772 337-0084
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2024
Certificate Expiration Date 10/14/2026
Facility Type Assisted Living Facility
Lab Director MICHELLE RHOADES

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