10D2206613 CLIA NUMBER - VINTAGE CARE SENIOR LIVING

Laboratory Demographics

  • CLIA Code: 10D2206613
  • Facility Name: VINTAGE CARE SENIOR LIVING
  • Facility Address: 203 SMITH MOODY RD
    PALATKA, FL
    ZIP 32177
  • Facility Phone: 386 329-9905
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: ANGELA WYNKOOP
  • NPI Number: 1558851048
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D2206613
LAB Type Assisted Living Facility
Facility Name VINTAGE CARE SENIOR LIVING
Street 203 SMITH MOODY RD
City PALATKA
State FL
ZIP 32177
Phone 386 329-9905
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/21/2024
Certificate Expiration Date 12/20/2026
Facility Type Assisted Living Facility
Lab Director ANGELA WYNKOOP

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