10D2213676 CLIA NUMBER - LAKESIDE NEUROLOGIC

Laboratory Demographics

  • CLIA Code: 10D2213676
  • Facility Name: LAKESIDE NEUROLOGIC
  • Facility Address: 1962 VANDOLAH RD
    WAUCHULA, FL
    ZIP 33873
  • Facility Phone: 863 245-6717
  • Facility Type: Other - TRANSITIONAL LIVING FACIL
  • Facility Type: Waiver
  • Lab Director: ONOLE M. WELLS
  • NPI Number: 1134722820
  • Taxonomy: 283X00000X - Rehabilitation Hospital

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CLIA Record

Field Name Field Value
CLIA Number 10D2213676
LAB Type Other - TRANSITIONAL LIVING FACIL
Facility Name LAKESIDE NEUROLOGIC
Street 1962 VANDOLAH RD
City WAUCHULA
State FL
ZIP 33873
Phone 863 245-6717
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2025
Certificate Expiration Date 2/15/2027
Facility Type Other - TRANSITIONAL LIVING FACIL
Lab Director ONOLE M. WELLS

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