52D2117536 CLIA NUMBER - JACKIE NITSCHKE CENTER, INC

Laboratory Demographics

  • CLIA Code: 52D2117536
  • Facility Name: JACKIE NITSCHKE CENTER, INC
  • Facility Address: 621 E WALNUT ST
    GREEN BAY, WI
    ZIP 54301
  • Facility Phone: 920 435-2093
  • Facility Type: Other - COMM BASED RES FACILITY
  • Facility Type: Waiver
  • Lab Director: MR. WILLIAM J. LABINE
  • NPI Number: 1265642318
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D2117536
LAB Type Other - COMM BASED RES FACILITY
Facility Name JACKIE NITSCHKE CENTER, INC
Street 621 E WALNUT ST
City GREEN BAY
State WI
ZIP 54301
Phone 920 435-2093
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2024
Certificate Expiration Date 8/17/2026
Facility Type Other - COMM BASED RES FACILITY
Lab Director MR. WILLIAM J. LABINE

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