52D0391656 CLIA NUMBER - LUTHER MANOR

Laboratory Demographics

  • CLIA Code: 52D0391656
  • Facility Name: LUTHER MANOR
  • Facility Address: 4545 N 92ND ST
    WAUWATOSA, WI
    ZIP 53225
  • Facility Phone: 414 464-3880
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MS. JOLIE KITZKE
  • NPI Number: 1639339518
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D0391656
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LUTHER MANOR
Street 4545 N 92ND ST
City WAUWATOSA
State WI
ZIP 53225
Phone 414 464-3880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MS. JOLIE KITZKE

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