52D0394594 CLIA NUMBER - EVERGREEN HEALTH SERVICES

Laboratory Demographics

  • CLIA Code: 52D0394594
  • Facility Name: EVERGREEN HEALTH SERVICES
  • Facility Address: 1250 S EVERGREEN ST
    SHAWANO, WI
    ZIP 54166
  • Facility Phone: 715 526-3107
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JENNIFER GOSSEN
  • NPI Number: 1316939861
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D0394594
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name EVERGREEN HEALTH SERVICES
Street 1250 S EVERGREEN ST
City SHAWANO
State WI
ZIP 54166
Phone 715 526-3107
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 JENNIFER GOSSEN

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