36D2196187 CLIA NUMBER - THE LODGE RETIREMENT COMMUNITY

Laboratory Demographics

  • CLIA Code: 36D2196187
  • Facility Name: THE LODGE RETIREMENT COMMUNITY
  • Facility Address: 12050 MONTGOMERY ROAD
    CINCINNATI, OH
    ZIP 45249
  • Facility Phone: 513 683-9966
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: SHAUN WITTROCK
  • NPI Number: 1811033756
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 36D2196187
LAB Type Assisted Living Facility
Facility Name THE LODGE RETIREMENT COMMUNITY
Street 12050 MONTGOMERY ROAD
City CINCINNATI
State OH
ZIP 45249
Phone 513 683-9966
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2024
Certificate Expiration Date 10/14/2026
Facility Type Assisted Living Facility
Lab Director SHAUN WITTROCK

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