36D2012009 CLIA NUMBER - FAIR HAVEN SHELBY COUNTY HOME

Laboratory Demographics

  • CLIA Code: 36D2012009
  • Facility Name: FAIR HAVEN SHELBY COUNTY HOME
  • Facility Address: 2901 FAIR ROAD
    SIDNEY, OH
    ZIP 45365
  • Facility Phone: 937 492-6900
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ANITA S. MILLER
  • NPI Number: 1376690461
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 36D2012009
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name FAIR HAVEN SHELBY COUNTY HOME
Street 2901 FAIR ROAD
City SIDNEY
State OH
ZIP 45365
Phone 937 492-6900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2024
Certificate Expiration Date 8/25/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director ANITA S. MILLER

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