52D2209912 CLIA NUMBER - WOLVERTON GLEN

Laboratory Demographics

  • CLIA Code: 52D2209912
  • Facility Name: WOLVERTON GLEN
  • Facility Address: 50 WOLVERTON AVE
    RIPON, WI
    ZIP 54971
  • Facility Phone: 920 745-1199
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MS. HALEY HALL
  • NPI Number: 1700397312
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D2209912
LAB Type Assisted Living Facility
Facility Name WOLVERTON GLEN
Street 50 WOLVERTON AVE
City RIPON
State WI
ZIP 54971
Phone 920 745-1199
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2025
Certificate Expiration Date 1/18/2027
Facility Type Assisted Living Facility
Lab Director MS. HALEY HALL

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