36D1002841 CLIA NUMBER - WESTERN RESERVE MASONIC COMMUNITY INC

Laboratory Demographics

  • CLIA Code: 36D1002841
  • Facility Name: WESTERN RESERVE MASONIC COMMUNITY INC
  • Facility Address: 4931 NETTLETON ROAD
    MEDINA, OH
    ZIP 44256
  • Facility Phone: 330 721-3000
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: NICOLE BERTKE
  • NPI Number: 1740515865
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 36D1002841
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name WESTERN RESERVE MASONIC COMMUNITY INC
Street 4931 NETTLETON ROAD
City MEDINA
State OH
ZIP 44256
Phone 330 721-3000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2024
Certificate Expiration Date 8/14/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director NICOLE BERTKE

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