16D2253351 CLIA NUMBER - SHADE OF THE TREE

Laboratory Demographics

  • CLIA Code: 16D2253351
  • Facility Name: SHADE OF THE TREE
  • Facility Address: 1601 KEOKUK AVE
    SPIRIT LAKE, IA
    ZIP 51360
  • Facility Phone: 712 330-9140
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: DANIEL GIGSTAD
  • NPI Number: 1104196096
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 16D2253351
LAB Type Comp. Outpatient Rehab Facility
Facility Name SHADE OF THE TREE
Street 1601 KEOKUK AVE
City SPIRIT LAKE
State IA
ZIP 51360
Phone 712 330-9140
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director DANIEL GIGSTAD

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