52D0389393 CLIA NUMBER - SOUTHPORT HEALTHCARE LLC DBA KENOSHA VISITING NURSE ASSOCIATION

Laboratory Demographics

  • CLIA Code: 52D0389393
  • Facility Name: SOUTHPORT HEALTHCARE LLC DBA KENOSHA VISITING NURSE ASSOCIATION
  • Facility Address: 600 52ND ST, SUITE 300
    KENOSHA, WI
    ZIP 53140
  • Facility Phone: 262 656-8400
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: SHELLY DARMODY
  • NPI Number: 1215900154
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 52D0389393
LAB Type Home Health Agency
Facility Name SOUTHPORT HEALTHCARE LLC DBA KENOSHA VISITING NURSE ASSOCIATION
Street 600 52ND ST, SUITE 300
City KENOSHA
State WI
ZIP 53140
Phone 262 656-8400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2025
Certificate Expiration Date 6/28/2027
Facility Type Home Health Agency
Lab Director SHELLY DARMODY

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