52D2069408 CLIA NUMBER - LAKE HALLIE MEMORY CARE

Laboratory Demographics

  • CLIA Code: 52D2069408
  • Facility Name: LAKE HALLIE MEMORY CARE
  • Facility Address: 4407 124TH ST
    CHIPPEWA FALLS, WI
    ZIP 54729
  • Facility Phone: 715 738-0011
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MR. BRAD GOEMAN
  • NPI Number: 1508115395
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2069408
LAB Type Assisted Living Facility
Facility Name LAKE HALLIE MEMORY CARE
Street 4407 124TH ST
City CHIPPEWA FALLS
State WI
ZIP 54729
Phone 715 738-0011
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2023
Certificate Expiration Date 11/24/2025
Facility Type Assisted Living Facility
Lab Director MR. BRAD GOEMAN

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