34D2130092 CLIA NUMBER - ROSE GLEN MANOR

Laboratory Demographics

  • CLIA Code: 34D2130092
  • Facility Name: ROSE GLEN MANOR
  • Facility Address: 240 INDEPENDENCE AVENUE
    NORTH WILKESBORO, NC
    ZIP 28659
  • Facility Phone: 336 818-3411
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: PENNY WATERS
  • NPI Number: 1033568258
  • Taxonomy: 311ZA0620X - Custodial Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 34D2130092
LAB Type Assisted Living Facility
Facility Name ROSE GLEN MANOR
Street 240 INDEPENDENCE AVENUE
City NORTH WILKESBORO
State NC
ZIP 28659
Phone 336 818-3411
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2025
Certificate Expiration Date 5/1/2027
Facility Type Assisted Living Facility
Lab Director PENNY WATERS

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