52D2192005 CLIA NUMBER - FORSETTI- TENNYSON LLC DBA TENNYSON ASSISTED LIVING

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Laboratory Demographics

CLIA Number: 52D2192005

Facility Name: FORSETTI- TENNYSON LLC DBA TENNYSON ASSISTED LIVING

Facility Address:
1936 TENNYSON LN
MADISON, WI
ZIP 53704
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Facility Phone Number: 608 268-9645

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1225652225

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	52D2192005
LAB Type	Assisted Living Facility
Facility Name	FORSETTI- TENNYSON LLC DBA TENNYSON ASSISTED LIVING
Street	1936 TENNYSON LN
City	MADISON
State	WI
ZIP	53704
Phone	608 268-9645
CertificateType	4
CertificateEffectiveDate	9/3/2022
CertificateExpirationDate	9/2/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024