52D0976128 CLIA NUMBER - ODYSSEY HEALTHCARE HOLDING COMPANY DBA HEARTLAND HOSPICE (GREEN BAY)

Laboratory Demographics

  • CLIA Code: 52D0976128
  • Facility Name: ODYSSEY HEALTHCARE HOLDING COMPANY DBA HEARTLAND HOSPICE (GREEN BAY)
  • Facility Address: 1145 WEST MAIN AVENUE, STE 205
    DE PERE, WI
    ZIP 54115
  • Facility Phone: 920 336-6455
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: SELECE BEASLEY
  • NPI Number: 1760127591
  • Taxonomy: 207RH0002X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 52D0976128
LAB Type Hospice
Facility Name ODYSSEY HEALTHCARE HOLDING COMPANY DBA HEARTLAND HOSPICE (GREEN BAY)
Street 1145 WEST MAIN AVENUE, STE 205
City DE PERE
State WI
ZIP 54115
Phone 920 336-6455
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/25/2024
Certificate Expiration Date 7/24/2026
Facility Type Hospice
Lab Director SELECE BEASLEY

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