52D2205913 CLIA NUMBER - INNOVATIVE SERVICES INC

Laboratory Demographics

CLIA Code: 52D2205913
Facility Name: INNOVATIVE SERVICES INC
Facility Address: 2321 SAN LUIS PL
GREEN BAY, WI
ZIP 54304
Facility Phone: 920 431-0962
Facility Type: Other - COMMUNITY SUPPORTD LIVING
Facility Type: Waiver
Lab Director: MR. JEFF MILLER
NPI Number: 1437433562
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	52D2205913
LAB Type	Other - COMMUNITY SUPPORTD LIVING
Facility Name	INNOVATIVE SERVICES INC
Street	2321 SAN LUIS PL
City	GREEN BAY
State	WI
ZIP	54304
Phone	920 431-0962
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	12/16/2024
Certificate Expiration Date	12/15/2026
Facility Type	Other - COMMUNITY SUPPORTD LIVING
Lab Director	MR. JEFF MILLER

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