52D1013469 CLIA NUMBER - LIFECARE MANOR LIFECARE HOMES INC

Laboratory Demographics

CLIA Code: 52D1013469
Facility Name: LIFECARE MANOR LIFECARE HOMES INC
Facility Address: 4013 S 119TH ST
GREENFIELD, WI
ZIP 53228
Facility Phone: 262 782-6068
Facility Type: Other
Facility Type: Waiver
Lab Director: NICOLETTE LINDSTROM
NPI Number: 1689829939
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	52D1013469
LAB Type	Other
Facility Name	LIFECARE MANOR LIFECARE HOMES INC
Street	4013 S 119TH ST
City	GREENFIELD
State	WI
ZIP	53228
Phone	262 782-6068
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/10/2025
Certificate Expiration Date	6/9/2027
Facility Type	Other
Lab Director	NICOLETTE LINDSTROM

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