10D2210842 CLIA NUMBER - COUNTRYSIDE HAVEN ASSISTED LIVING LLC

Laboratory Demographics

CLIA Number: 10D2210842

Facility Name: COUNTRYSIDE HAVEN ASSISTED LIVING LLC

Facility Address:
6960 COUNTY RD 95
PALM HARBOR, FL
ZIP 34684
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Facility Phone Number: 727 534-6766

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1396281887

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	10D2210842
LAB Type	Assisted Living Facility
Facility Name	COUNTRYSIDE HAVEN ASSISTED LIVING LLC
Street	6960 COUNTY RD 95
City	PALM HARBOR
State	FL
ZIP	34684
Phone	727 534-6766
CertificateType	4
CertificateEffectiveDate	1/25/2023
CertificateExpirationDate	1/24/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024