52D1089104 CLIA NUMBER - LAKESHORE MANOR

Laboratory Demographics

  • CLIA Code: 52D1089104
  • Facility Name: LAKESHORE MANOR
  • Facility Address: 711 BAYSHORE DR
    OSHKOSH, WI
    ZIP 54901
  • Facility Phone: 920 426-2670
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: KRYSTAL BITTNER
  • NPI Number: 1699350397
  • Taxonomy: 376G00000X - Nursing Home Administrator

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CLIA Record

Field Name Field Value
CLIA Number 52D1089104
LAB Type Assisted Living Facility
Facility Name LAKESHORE MANOR
Street 711 BAYSHORE DR
City OSHKOSH
State WI
ZIP 54901
Phone 920 426-2670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/22/2025
Certificate Expiration Date 4/21/2027
Facility Type Assisted Living Facility
Lab Director KRYSTAL BITTNER

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