13D2054638 CLIA NUMBER - LAKESIDE REHABILITATION AND CARE CENTER

Laboratory Demographics

  • CLIA Code: 13D2054638
  • Facility Name: LAKESIDE REHABILITATION AND CARE CENTER
  • Facility Address: 210 W LACROSSE AVE
    COEUR D'ALENE, ID
    ZIP 83814
  • Facility Phone: 208 664-2185
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MICHAEL MEZA
  • NPI Number: 1881837243
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 13D2054638
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LAKESIDE REHABILITATION AND CARE CENTER
Street 210 W LACROSSE AVE
City COEUR D'ALENE
State ID
ZIP 83814
Phone 208 664-2185
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/26/2025
Certificate Expiration Date 2/25/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MICHAEL MEZA

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