20D0705847 CLIA NUMBER - ROSS MANOR

Laboratory Demographics

  • CLIA Code: 20D0705847
  • Facility Name: ROSS MANOR
  • Facility Address: 758 BROADWAY
    BANGOR, ME
    ZIP 04401
  • Facility Phone: 207 941-8400
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DALE C. WALKER MD
  • NPI Number: 1790910883
  • Taxonomy: 311500000X - Alzheimer Center (Dementia Center)

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CLIA Record

Field Name Field Value
CLIA Number 20D0705847
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name ROSS MANOR
Street 758 BROADWAY
City BANGOR
State ME
ZIP 04401
Phone 207 941-8400
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 DALE C. WALKER MD

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