52D0675851 CLIA NUMBER - MANOR FOND DU LAC, THE

Laboratory Demographics

  • CLIA Code: 52D0675851
  • Facility Name: MANOR FOND DU LAC, THE
  • Facility Address: 517 E DIVISION STREET
    FOND DU LAC, WI
    ZIP 54935
  • Facility Phone: 920 921-6800
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ROSIE RHODE
  • NPI Number: 1295721991
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D0675851
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MANOR FOND DU LAC, THE
Street 517 E DIVISION STREET
City FOND DU LAC
State WI
ZIP 54935
Phone 920 921-6800
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 ROSIE RHODE

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