34D0940687 CLIA NUMBER - MAPLE LEAF HEALTH CARE

Laboratory Demographics

  • CLIA Code: 34D0940687
  • Facility Name: MAPLE LEAF HEALTH CARE
  • Facility Address: 2640 DAVIE AVE
    STATESVILLE, NC
    ZIP 28677
  • Facility Phone: 704 871-0705
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Microscopy
  • Lab Director: JENNIFER SIMEN
  • NPI Number: 1992825848
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D0940687
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MAPLE LEAF HEALTH CARE
Street 2640 DAVIE AVE
City STATESVILLE
State NC
ZIP 28677
Phone 704 871-0705
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/13/2024
Certificate Expiration Date 2/12/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JENNIFER SIMEN

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