10D2012722 CLIA NUMBER - STEPHENS MEMORIAL HOME

Laboratory Demographics

  • CLIA Code: 10D2012722
  • Facility Name: STEPHENS MEMORIAL HOME
  • Facility Address: 5805 DATIL PEPPER RD
    SAINT AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 904 797-0294
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: BRENDA STEPHENS
  • NPI Number: 1316381890
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D2012722
LAB Type Assisted Living Facility
Facility Name STEPHENS MEMORIAL HOME
Street 5805 DATIL PEPPER RD
City SAINT AUGUSTINE
State FL
ZIP 32086
Phone 904 797-0294
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/8/2024
Certificate Expiration Date 9/7/2026
Facility Type Assisted Living Facility
Lab Director BRENDA STEPHENS

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