23D2078500 CLIA NUMBER - MAPLE LAKE ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 23D2078500
  • Facility Name: MAPLE LAKE ASSISTED LIVING
  • Facility Address: 677 HAZEN ST
    PAW PAW, MI
    ZIP 49079
  • Facility Phone: 269 657-0190
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: BRANDI KONATE
  • NPI Number: 1306279740
  • Taxonomy: 302F00000X - Exclusive Provider Organization

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 23D2078500
LAB Type Assisted Living Facility
Facility Name MAPLE LAKE ASSISTED LIVING
Street 677 HAZEN ST
City PAW PAW
State MI
ZIP 49079
Phone 269 657-0190
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2024
Certificate Expiration Date 5/29/2026
Facility Type Assisted Living Facility
Lab Director BRANDI KONATE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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