10D2220153 CLIA NUMBER - HAINES CITY SLC OPCO, LLC DBA CLUB AT HAINES CITY, THE

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Laboratory Demographics

CLIA Number: 10D2220153

Facility Name: HAINES CITY SLC OPCO, LLC DBA CLUB AT HAINES CITY, THE

Facility Address:
301 PENINSULAR DR
HAINES CITY, FL
ZIP 33844
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Facility Phone Number: 863 422-5204

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1659019685

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	10D2220153
LAB Type	Assisted Living Facility
Facility Name	HAINES CITY SLC OPCO, LLC DBA CLUB AT HAINES CITY, THE
Street	301 PENINSULAR DR
City	HAINES CITY
State	FL
ZIP	33844
Phone	863 422-5204
CertificateType	4
CertificateEffectiveDate	4/9/2023
CertificateExpirationDate	4/8/2025
FacilityType	Waiver

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