39D0897258 CLIA NUMBER - PATRIOT VILLAGE

Laboratory Demographics

  • CLIA Code: 39D0897258
  • Facility Name: PATRIOT VILLAGE
  • Facility Address: 495 WEST PATRIOT STREET
    SOMERSET, PA
    ZIP 15501
  • Facility Phone: 814 445-4549
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: CRAIG FOCKLER
  • NPI Number: 1366281818
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 39D0897258
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PATRIOT VILLAGE
Street 495 WEST PATRIOT STREET
City SOMERSET
State PA
ZIP 15501
Phone 814 445-4549
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2025
Certificate Expiration Date 1/31/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director CRAIG FOCKLER

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