52D1068446 CLIA NUMBER - HEARTLAND HOUSE

Laboratory Demographics

  • CLIA Code: 52D1068446
  • Facility Name: HEARTLAND HOUSE
  • Facility Address: 668 W CUMMINGS RD
    WAUTOMA, WI
    ZIP 54982
  • Facility Phone: 920 787-2467
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: BEVERLY A. WALKER, LPN
  • NPI Number: 1205885712
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 52D1068446
LAB Type Assisted Living Facility
Facility Name HEARTLAND HOUSE
Street 668 W CUMMINGS RD
City WAUTOMA
State WI
ZIP 54982
Phone 920 787-2467
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Assisted Living Facility
Lab Director BEVERLY A. WALKER, LPN

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