52D2157359 CLIA NUMBER - ADAVA CARE OF IRISH ROAD

Laboratory Demographics

  • CLIA Code: 52D2157359
  • Facility Name: ADAVA CARE OF IRISH ROAD
  • Facility Address: 1760 IRISH ROAD
    NEENAH, WI
    ZIP 54956
  • Facility Phone: 414 944-9314
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: KUROSH DEJGOSHA
  • NPI Number: 1871972554
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 52D2157359
LAB Type Assisted Living Facility
Facility Name ADAVA CARE OF IRISH ROAD
Street 1760 IRISH ROAD
City NEENAH
State WI
ZIP 54956
Phone 414 944-9314
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2024
Certificate Expiration Date 11/4/2026
Facility Type Assisted Living Facility
Lab Director KUROSH DEJGOSHA

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