14D0413980 CLIA NUMBER - AVANTARA PARK RIDGE

Laboratory Demographics

  • CLIA Code: 14D0413980
  • Facility Name: AVANTARA PARK RIDGE
  • Facility Address: 1601 N WESTERN AVENUE
    PARK RIDGE, IL
    ZIP 60068
  • Facility Phone: 708 825-5531
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DOROTHY MC DONALD
  • NPI Number: 1427461292
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0413980
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AVANTARA PARK RIDGE
Street 1601 N WESTERN AVENUE
City PARK RIDGE
State IL
ZIP 60068
Phone 708 825-5531
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director DOROTHY MC DONALD

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