10D2112546 CLIA NUMBER - GRAND VILLA OF DELAND

Laboratory Demographics

  • CLIA Code: 10D2112546
  • Facility Name: GRAND VILLA OF DELAND
  • Facility Address: 350 E INTERNATIONAL SPEEDWAY BLVD
    DELAND, FL
    ZIP 32724
  • Facility Phone: 386 738-5200
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: KEITH FEDIGAN
  • NPI Number: 1770958142
  • Taxonomy: 310400000X - Assisted Living Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 10D2112546
LAB Type Assisted Living Facility
Facility Name GRAND VILLA OF DELAND
Street 350 E INTERNATIONAL SPEEDWAY BLVD
City DELAND
State FL
ZIP 32724
Phone 386 738-5200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2024
Certificate Expiration Date 5/2/2026
Facility Type Assisted Living Facility
Lab Director KEITH FEDIGAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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