52D2036111 CLIA NUMBER - SOUTHMOOR

Laboratory Demographics

  • CLIA Code: 52D2036111
  • Facility Name: SOUTHMOOR
  • Facility Address: 2833 S 12TH ST
    SHEBOYGAN, WI
    ZIP 53081
  • Facility Phone: 414 534-2979
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MS. RUTH S. KANTROWITZ

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CLIA Record

Field Name Field Value
CLIA Number 52D2036111
LAB Type Assisted Living Facility
Facility Name SOUTHMOOR
Street 2833 S 12TH ST
City SHEBOYGAN
State WI
ZIP 53081
Phone 414 534-2979
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2024
Certificate Expiration Date 1/31/2026
Facility Type Assisted Living Facility
Lab Director MS. RUTH S. KANTROWITZ

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This page was last updated on: 6/4/2025