10D2112580 CLIA NUMBER - GRAND VILLA OF LAKELAND

Laboratory Demographics

  • CLIA Code: 10D2112580
  • Facility Name: GRAND VILLA OF LAKELAND
  • Facility Address: 2111 LAKELAND HILLS BLVD
    LAKELAND, FL
    ZIP 33805
  • Facility Phone: 863 688-1126
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: TYRUS HAWKINS
  • NPI Number: 1457726838
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D2112580
LAB Type Assisted Living Facility
Facility Name GRAND VILLA OF LAKELAND
Street 2111 LAKELAND HILLS BLVD
City LAKELAND
State FL
ZIP 33805
Phone 863 688-1126
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 TYRUS HAWKINS

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