52D2286563 CLIA NUMBER - GOLDEN YEARS OF RANDOLPH

Laboratory Demographics

  • CLIA Code: 52D2286563
  • Facility Name: GOLDEN YEARS OF RANDOLPH
  • Facility Address: 131 ELLIS AVE
    RANDOLPH, WI
    ZIP 53956
  • Facility Phone: 920 400-9322
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: SHAYLA THOMPSON
  • NPI Number: 1598541070
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 52D2286563
LAB Type Assisted Living Facility
Facility Name GOLDEN YEARS OF RANDOLPH
Street 131 ELLIS AVE
City RANDOLPH
State WI
ZIP 53956
Phone 920 400-9322
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2025
Certificate Expiration Date 7/31/2027
Facility Type Assisted Living Facility
Lab Director SHAYLA THOMPSON

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