52D0882881 CLIA NUMBER - EVANSVILLE MANOR

Laboratory Demographics

  • CLIA Code: 52D0882881
  • Facility Name: EVANSVILLE MANOR
  • Facility Address: 470 GARFIELD AVE
    EVANSVILLE, WI
    ZIP 53536
  • Facility Phone: 608 882-5700
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JOCELYN GLASS
  • NPI Number: 1609863794
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D0882881
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name EVANSVILLE MANOR
Street 470 GARFIELD AVE
City EVANSVILLE
State WI
ZIP 53536
Phone 608 882-5700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/19/2024
Certificate Expiration Date 2/18/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JOCELYN GLASS

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