10D2216669 CLIA NUMBER - LAKELAND MANOR ALF

Laboratory Demographics

CLIA Number: 10D2216669

Facility Name: LAKELAND MANOR ALF

Facility Address:
747 BON AIR STREET
LAKELAND, FL
ZIP 33805
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Facility Phone Number: 863 583-4889

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1083095129

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	10D2216669
LAB Type	Assisted Living Facility
Facility Name	LAKELAND MANOR ALF
Street	747 BON AIR STREET
City	LAKELAND
State	FL
ZIP	33805
Phone	863 583-4889
CertificateType	4
CertificateEffectiveDate	3/15/2023
CertificateExpirationDate	3/14/2025
FacilityType	Waiver

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