20D0089012 CLIA NUMBER - MONTELLO MANOR

Laboratory Demographics

  • CLIA Code: 20D0089012
  • Facility Name: MONTELLO MANOR
  • Facility Address: 540 COLLEGE STREET
    LEWISTON, ME
    ZIP 04240
  • Facility Phone: 207 783-2039
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: NICOLE S. BOUTAUGH
  • NPI Number: 1154350700
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 20D0089012
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MONTELLO MANOR
Street 540 COLLEGE STREET
City LEWISTON
State ME
ZIP 04240
Phone 207 783-2039
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director NICOLE S. BOUTAUGH

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