52D2308046 CLIA NUMBER - PRADO HOSPICE, LLC

Laboratory Demographics

  • CLIA Code: 52D2308046
  • Facility Name: PRADO HOSPICE, LLC
  • Facility Address: 6165 N GREEN BAY AVE
    GLENDALE, WI
    ZIP 53209
  • Facility Phone: 262 951-1423
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: TANYA S. WILBURN
  • NPI Number: 1972373652
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 52D2308046
LAB Type Hospice
Facility Name PRADO HOSPICE, LLC
Street 6165 N GREEN BAY AVE
City GLENDALE
State WI
ZIP 53209
Phone 262 951-1423
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2024
Certificate Expiration Date 7/18/2026
Facility Type Hospice
Lab Director TANYA S. WILBURN

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