23D0379721 CLIA NUMBER - ROOSEVELT PARK NURSING

Laboratory Demographics

  • CLIA Code: 23D0379721
  • Facility Name: ROOSEVELT PARK NURSING
  • Facility Address: 1300 W BROADWAY AVE
    MUSKEGON, MI
    ZIP 49441
  • Facility Phone: 231 755-2221
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: PURNELL PENNY CARLSON
  • NPI Number: 1255339354
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 23D0379721
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name ROOSEVELT PARK NURSING
Street 1300 W BROADWAY AVE
City MUSKEGON
State MI
ZIP 49441
Phone 231 755-2221
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 PURNELL PENNY CARLSON

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