52D2079869 CLIA NUMBER - EVERGREEN AT HOME, HOME HEALTH

Laboratory Demographics

  • CLIA Code: 52D2079869
  • Facility Name: EVERGREEN AT HOME, HOME HEALTH
  • Facility Address: 1125 N WESTFIELD ST
    OSHKOSH, WI
    ZIP 54902
  • Facility Phone: 920 237-7242
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: MS. CHANDAROSE LOSKOT
  • NPI Number: 1144213281
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D2079869
LAB Type Home Health Agency
Facility Name EVERGREEN AT HOME, HOME HEALTH
Street 1125 N WESTFIELD ST
City OSHKOSH
State WI
ZIP 54902
Phone 920 237-7242
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2024
Certificate Expiration Date 6/24/2026
Facility Type Home Health Agency
Lab Director MS. CHANDAROSE LOSKOT

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