52D2310883 CLIA NUMBER - CREATIVE COMMUNITY LIVING SERVICES, INC- BLACK RIVER FALLS

Laboratory Demographics

  • CLIA Code: 52D2310883
  • Facility Name: CREATIVE COMMUNITY LIVING SERVICES, INC- BLACK RIVER FALLS
  • Facility Address: 323 SOUTH 2ND STREET
    BLACK RIVER FALLS, WI
    ZIP 54615
  • Facility Phone: 920 261-1345
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: KATHLEEN J. ROACH
  • NPI Number: 1265625834
  • Taxonomy: 251C00000X - Day Training, Developmentally Disabled Services

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CLIA Record

Field Name Field Value
CLIA Number 52D2310883
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name CREATIVE COMMUNITY LIVING SERVICES, INC- BLACK RIVER FALLS
Street 323 SOUTH 2ND STREET
City BLACK RIVER FALLS
State WI
ZIP 54615
Phone 920 261-1345
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director KATHLEEN J. ROACH

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