36D0897606 CLIA NUMBER - LAKE COUNTY BOARD OF DD/DEEPWOOD

Laboratory Demographics

  • CLIA Code: 36D0897606
  • Facility Name: LAKE COUNTY BOARD OF DD/DEEPWOOD
  • Facility Address: 8121 DEEPWOOD BLVD
    MENTOR, OH
    ZIP 44060
  • Facility Phone: 440 350-5095
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: ROBIN R. IRONS
  • NPI Number: 1396292405
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 36D0897606
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name LAKE COUNTY BOARD OF DD/DEEPWOOD
Street 8121 DEEPWOOD BLVD
City MENTOR
State OH
ZIP 44060
Phone 440 350-5095
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2025
Certificate Expiration Date 2/8/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director ROBIN R. IRONS

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