52D2175793 CLIA NUMBER - BEAVER DAM AL OPERATIONS, LLC DBA CHARLESTON HOUSE AL

Laboratory Demographics

  • CLIA Code: 52D2175793
  • Facility Name: BEAVER DAM AL OPERATIONS, LLC DBA CHARLESTON HOUSE AL
  • Facility Address: 104 FAKES CT
    BEAVER DAM, WI
    ZIP 53916
  • Facility Phone: 763 670-9077
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: KRYSTAL BITTNER
  • NPI Number: 1265090559
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D2175793
LAB Type Assisted Living Facility
Facility Name BEAVER DAM AL OPERATIONS, LLC DBA CHARLESTON HOUSE AL
Street 104 FAKES CT
City BEAVER DAM
State WI
ZIP 53916
Phone 763 670-9077
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2023
Certificate Expiration Date 12/1/2025
Facility Type Assisted Living Facility
Lab Director KRYSTAL BITTNER

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