51D0915154 CLIA NUMBER - CLINIC LEASING CO, LLC

Laboratory Demographics

  • CLIA Code: 51D0915154
  • Facility Name: CLINIC LEASING CO, LLC
  • Facility Address: 1053 CLINIC DR
    IVYDALE, WV
    ZIP 25113
  • Facility Phone: 304 286-4204
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DR. JEANETTE JACKSON
  • NPI Number: 1104530682
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 51D0915154
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CLINIC LEASING CO, LLC
Street 1053 CLINIC DR
City IVYDALE
State WV
ZIP 25113
Phone 304 286-4204
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2024
Certificate Expiration Date 5/20/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director DR. JEANETTE JACKSON

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