52D1059400 CLIA NUMBER - SKY RESIDENTIAL BROOKSIDE

Laboratory Demographics

CLIA Code: 52D1059400
Facility Name: SKY RESIDENTIAL BROOKSIDE
Facility Address: 2405 S BROOKSIDE PKWY
NEW BERLIN, WI
ZIP 53151
Facility Phone: 262 821-1406
Facility Type: Assisted Living Facility
Facility Type: Waiver
Lab Director: MS. KIM D. NGUYEN
NPI Number: 1821241464
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	52D1059400
LAB Type	Assisted Living Facility
Facility Name	SKY RESIDENTIAL BROOKSIDE
Street	2405 S BROOKSIDE PKWY
City	NEW BERLIN
State	WI
ZIP	53151
Phone	262 821-1406
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/28/2024
Certificate Expiration Date	9/27/2026
Facility Type	Assisted Living Facility
Lab Director	MS. KIM D. NGUYEN

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