52D0977089 CLIA NUMBER - GRANDE PRAIRIE CARE AND REHAB CENTER

Laboratory Demographics

  • CLIA Code: 52D0977089
  • Facility Name: GRANDE PRAIRIE CARE AND REHAB CENTER
  • Facility Address: 10330 PRAIRIE RIDGE RD
    PLEASANT PRAIRIE, WI
    ZIP 53158
  • Facility Phone: 262 612-2800
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DR. SARFRAZ SIDHU
  • NPI Number: 1003937475
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D0977089
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name GRANDE PRAIRIE CARE AND REHAB CENTER
Street 10330 PRAIRIE RIDGE RD
City PLEASANT PRAIRIE
State WI
ZIP 53158
Phone 262 612-2800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2024
Certificate Expiration Date 8/20/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director DR. SARFRAZ SIDHU

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