52D2068033 CLIA NUMBER - ADAVA CARE OF GLENDALE 1

Laboratory Demographics

  • CLIA Code: 52D2068033
  • Facility Name: ADAVA CARE OF GLENDALE 1
  • Facility Address: 7325 N PORT WASHINGTON RD
    GLENDALE, WI
    ZIP 53217
  • Facility Phone: 414 944-9314
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: KUROSH DEJGOSHA
  • NPI Number: 1295064921
  • Taxonomy: 163W00000X - Registered Nurse

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CLIA Record

Field Name Field Value
CLIA Number 52D2068033
LAB Type Assisted Living Facility
Facility Name ADAVA CARE OF GLENDALE 1
Street 7325 N PORT WASHINGTON RD
City GLENDALE
State WI
ZIP 53217
Phone 414 944-9314
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Assisted Living Facility
Lab Director KUROSH DEJGOSHA

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