39D0886113 CLIA NUMBER - LOCUST GROVE RETIREMENT VILLAGE

Laboratory Demographics

  • CLIA Code: 39D0886113
  • Facility Name: LOCUST GROVE RETIREMENT VILLAGE
  • Facility Address: 69 COTTAGE ROAD
    MIFFLIN, PA
    ZIP 17058
  • Facility Phone: 717 436-8921
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DR. BRANDON M. ROSCOE
  • NPI Number: 1265448690
  • Taxonomy: 314000000X - Skilled Nursing Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 39D0886113
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LOCUST GROVE RETIREMENT VILLAGE
Street 69 COTTAGE ROAD
City MIFFLIN
State PA
ZIP 17058
Phone 717 436-8921
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2024
Certificate Expiration Date 5/12/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director DR. BRANDON M. ROSCOE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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