52D1106004 CLIA NUMBER - MORAINE RIDGE ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 52D1106004
  • Facility Name: MORAINE RIDGE ASSISTED LIVING
  • Facility Address: 2929 ST ANTHONY DR STE 101
    GREEN BAY, WI
    ZIP 54302
  • Facility Phone: 920 468-3111
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: DOUGLAS HENNIG
  • NPI Number: 1053282020
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D1106004
LAB Type Assisted Living Facility
Facility Name MORAINE RIDGE ASSISTED LIVING
Street 2929 ST ANTHONY DR STE 101
City GREEN BAY
State WI
ZIP 54302
Phone 920 468-3111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2025
Certificate Expiration Date 10/1/2027
Facility Type Assisted Living Facility
Lab Director DOUGLAS HENNIG

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