52D2077432 CLIA NUMBER - ST CROIX HOSPICE LLC

Laboratory Demographics

  • CLIA Code: 52D2077432
  • Facility Name: ST CROIX HOSPICE LLC
  • Facility Address: 830 STATE RD 136 STE 3
    BARABOO, WI
    ZIP 53913
  • Facility Phone: 608 448-4200
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: MICKKI PRUSSING
  • NPI Number: 1649589540
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 52D2077432
LAB Type Hospice
Facility Name ST CROIX HOSPICE LLC
Street 830 STATE RD 136 STE 3
City BARABOO
State WI
ZIP 53913
Phone 608 448-4200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2024
Certificate Expiration Date 5/6/2026
Facility Type Hospice
Lab Director MICKKI PRUSSING

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