50D2292594 CLIA NUMBER - LAKE STEVENS MANOR ADULT FAMILY HOME LLC

Laboratory Demographics

  • CLIA Code: 50D2292594
  • Facility Name: LAKE STEVENS MANOR ADULT FAMILY HOME LLC
  • Facility Address: 2505 121ST DR NE
    LAKE STEVENS, WA
    ZIP 98258
  • Facility Phone: 425 374-7443
  • Facility Type: Other - AFH
  • Facility Type: Waiver
  • Lab Director: KLINNIE NYALE
  • NPI Number: 1689861270
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 50D2292594
LAB Type Other - AFH
Facility Name LAKE STEVENS MANOR ADULT FAMILY HOME LLC
Street 2505 121ST DR NE
City LAKE STEVENS
State WA
ZIP 98258
Phone 425 374-7443
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 4/4/2028
Facility Type Other - AFH
Lab Director KLINNIE NYALE

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