10D2295135 CLIA NUMBER - ST CLOUD SLC OPCO LLC DBA THE CLUB AT STCLOUD

Laboratory Demographics

  • CLIA Code: 10D2295135
  • Facility Name: ST CLOUD SLC OPCO LLC DBA THE CLUB AT STCLOUD
  • Facility Address: 3791 OLD CANOE CREEK RD
    SAINT CLOUD, FL
    ZIP 34772
  • Facility Phone: 407 892-8502
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JUDITH MELLON
  • NPI Number: 1295435311
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D2295135
LAB Type Assisted Living Facility
Facility Name ST CLOUD SLC OPCO LLC DBA THE CLUB AT STCLOUD
Street 3791 OLD CANOE CREEK RD
City SAINT CLOUD
State FL
ZIP 34772
Phone 407 892-8502
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/6/2023
Certificate Expiration Date 12/5/2025
Facility Type Assisted Living Facility
Lab Director JUDITH MELLON

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