14D0411884 CLIA NUMBER - CHILDREN & TEENS MEDICAL CENTER

Laboratory Demographics

CLIA Number: 14D0411884

Facility Name: CHILDREN & TEENS MEDICAL CENTER

Facility Address:
27401 W HIGHWAY 22 SUITE 103
LAKE BARRINGTON, IL
ZIP 60010
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Facility Phone Number: 847 382-8900

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1376779512

Taxonomy: 225400000X - Rehabilitation Practitioner
A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.

CLIA Record

Field Name	Field Value
CLIA Number	14D0411884
LAB Type	Physician Office
Facility Name	CHILDREN & TEENS MEDICAL CENTER
Street	27401 W HIGHWAY 22 SUITE 103
City	LAKE BARRINGTON
State	IL
ZIP	60010
Phone	847 382-8900
CertificateType	4
CertificateEffectiveDate	8/20/2023
CertificateExpirationDate	8/19/2025
FacilityType	Waiver

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