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52D0723137 CLIA NUMBER - ST JOSEPH'S HOME OF OUR LADY OF MT CARMEL, INC

Laboratory Demographics

CLIA Number: 52D0723137

Facility Name: ST JOSEPH'S HOME OF OUR LADY OF MT CARMEL, INC

Facility Address:
9244 29TH AVENUE
KENOSHA, WI
ZIP 53143
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Facility Phone Number: 262 694-0080

Facility Type: Assisted Living Facility

Certificate Type: Waiver
NPI Number: 1740270735

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name Field Value
CLIA Number 52D0723137
LAB Type Assisted Living Facility
Facility Name ST JOSEPH'S HOME OF OUR LADY OF MT CARMEL, INC
Street 9244 29TH AVENUE
City KENOSHA
State WI
ZIP 53143
Phone 262 694-0080
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024