52D2122412 CLIA NUMBER - SBH-GREEN BAY, LLC DBA WILLOW CREEK BEHAVIORAL HEALTH

Laboratory Demographics

  • CLIA Code: 52D2122412
  • Facility Name: SBH-GREEN BAY, LLC DBA WILLOW CREEK BEHAVIORAL HEALTH
  • Facility Address: 1351 ONTARIO RD
    GREEN BAY, WI
    ZIP 54311
  • Facility Phone: 920 328-1220
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: DR. KHALID CHAUDHRY
  • NPI Number: 1861993172
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 52D2122412
LAB Type Hospital
Facility Name SBH-GREEN BAY, LLC DBA WILLOW CREEK BEHAVIORAL HEALTH
Street 1351 ONTARIO RD
City GREEN BAY
State WI
ZIP 54311
Phone 920 328-1220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/29/2024
Certificate Expiration Date 11/28/2026
Facility Type Hospital
Lab Director DR. KHALID CHAUDHRY

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