52D2057449 CLIA NUMBER - MENOMONIE CBRF, LLC

Laboratory Demographics

  • CLIA Code: 52D2057449
  • Facility Name: MENOMONIE CBRF, LLC
  • Facility Address: 2211 WHITE PINE LANE
    MENOMONIE, WI
    ZIP 54751
  • Facility Phone: 715 231-3020
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MS. MELINDA D. JOHNSON
  • NPI Number: 1487262564
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D2057449
LAB Type Assisted Living Facility
Facility Name MENOMONIE CBRF, LLC
Street 2211 WHITE PINE LANE
City MENOMONIE
State WI
ZIP 54751
Phone 715 231-3020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2025
Certificate Expiration Date 4/16/2027
Facility Type Assisted Living Facility
Lab Director MS. MELINDA D. JOHNSON

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