52D0878947 CLIA NUMBER - HERITAGE HEALTH SYSTEMS

Laboratory Demographics

  • CLIA Code: 52D0878947
  • Facility Name: HERITAGE HEALTH SYSTEMS
  • Facility Address: 1119 N WISCONSIN ST
    PORT WASHINGTON, WI
    ZIP 53074
  • Facility Phone: 262 284-5892
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: WUA VANG
  • NPI Number: 1407927148
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D0878947
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name HERITAGE HEALTH SYSTEMS
Street 1119 N WISCONSIN ST
City PORT WASHINGTON
State WI
ZIP 53074
Phone 262 284-5892
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director WUA VANG

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This page was last updated on: 6/4/2025