43D1064935 CLIA NUMBER - COUNTRYSIDE INN ASSISTED AND

Laboratory Demographics

  • CLIA Code: 43D1064935
  • Facility Name: COUNTRYSIDE INN ASSISTED AND
  • Facility Address: 208 PRARIE AVENUE
    ROSHOLT, SD
    ZIP 57260
  • Facility Phone: 605 537-4588
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: DAVID BRANDELL
  • NPI Number: 1871600759
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 43D1064935
LAB Type Assisted Living Facility
Facility Name COUNTRYSIDE INN ASSISTED AND
Street 208 PRARIE AVENUE
City ROSHOLT
State SD
ZIP 57260
Phone 605 537-4588
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2025
Certificate Expiration Date 2/15/2027
Facility Type Assisted Living Facility
Lab Director DAVID BRANDELL

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