23D2205906 CLIA NUMBER - BRENTWOOD AT NILES

Laboratory Demographics

  • CLIA Code: 23D2205906
  • Facility Name: BRENTWOOD AT NILES
  • Facility Address: 1147 S 3RD ST
    NILES, MI
    ZIP 49120
  • Facility Phone: 269 684-9470
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: STEPHANIE LISENKO
  • NPI Number: 1639405608
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 23D2205906
LAB Type Assisted Living Facility
Facility Name BRENTWOOD AT NILES
Street 1147 S 3RD ST
City NILES
State MI
ZIP 49120
Phone 269 684-9470
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2024
Certificate Expiration Date 12/15/2026
Facility Type Assisted Living Facility
Lab Director STEPHANIE LISENKO

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