52D2193772 CLIA NUMBER - GOOD SHEPHERD SERVICES DBA FOREST GLEN CBRF

Laboratory Demographics

  • CLIA Code: 52D2193772
  • Facility Name: GOOD SHEPHERD SERVICES DBA FOREST GLEN CBRF
  • Facility Address: 721 E BRONSON RD
    SEYMOUR, WI
    ZIP 54165
  • Facility Phone: 920 833-6856
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MS. DEBORAH A. CAPTAIN
  • NPI Number: 1235106725
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D2193772
LAB Type Assisted Living Facility
Facility Name GOOD SHEPHERD SERVICES DBA FOREST GLEN CBRF
Street 721 E BRONSON RD
City SEYMOUR
State WI
ZIP 54165
Phone 920 833-6856
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/24/2024
Certificate Expiration Date 9/23/2026
Facility Type Assisted Living Facility
Lab Director MS. DEBORAH A. CAPTAIN

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