36D1083200 CLIA NUMBER - AVALON BY OTTERBEIN MONCLOVA

Laboratory Demographics

  • CLIA Code: 36D1083200
  • Facility Name: AVALON BY OTTERBEIN MONCLOVA
  • Facility Address: 5069 OTTERBEIN WAY
    MONCLOVA, OH
    ZIP 43542
  • Facility Phone: 419 878-0550
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: LISA M. HART
  • NPI Number: 1801919584
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 36D1083200
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AVALON BY OTTERBEIN MONCLOVA
Street 5069 OTTERBEIN WAY
City MONCLOVA
State OH
ZIP 43542
Phone 419 878-0550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2024
Certificate Expiration Date 4/28/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director LISA M. HART

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