36D1101463 CLIA NUMBER - BROOKSIDE

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Field Name	Field Value
CLIA Number	36D1101463
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	BROOKSIDE
Street	780 SNIDER ROAD
City	MASON
State	OH
ZIP	45040
Phone	513 398-1020
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/26/2025
Certificate Expiration Date	6/25/2027
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	STUART A. ZAKEM

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