52D0972148 CLIA NUMBER - HEARTHSIDE CBRF CORDIAL CARE CORP

Laboratory Demographics

  • CLIA Code: 52D0972148
  • Facility Name: HEARTHSIDE CBRF CORDIAL CARE CORP
  • Facility Address: 10569 FIELDCREST ROAD
    SISTER BAY, WI
    ZIP 54234
  • Facility Phone: 920 854-7225
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: MS. MARTHA L. COVENTRY
  • NPI Number: 1861616625
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D0972148
LAB Type Other
Facility Name HEARTHSIDE CBRF CORDIAL CARE CORP
Street 10569 FIELDCREST ROAD
City SISTER BAY
State WI
ZIP 54234
Phone 920 854-7225
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2024
Certificate Expiration Date 3/29/2026
Facility Type Other
Lab Director MS. MARTHA L. COVENTRY

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