52D2234021 CLIA NUMBER - NOHC MAGNOLIA MEADOWS LLC

Laboratory Demographics

CLIA Number: 52D2234021

Facility Name: NOHC MAGNOLIA MEADOWS LLC

Facility Address:
1480 N 7TH ST
MANITOWOC, WI
ZIP 54220
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Facility Phone Number: 920 686-0160

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1003427766

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	52D2234021
LAB Type	Assisted Living Facility
Facility Name	NOHC MAGNOLIA MEADOWS LLC
Street	1480 N 7TH ST
City	MANITOWOC
State	WI
ZIP	54220
Phone	920 686-0160
CertificateType	4
CertificateEffectiveDate	8/27/2023
CertificateExpirationDate	8/26/2025
FacilityType	Waiver

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