14D0432450 CLIA NUMBER - FAIRVIEW HAVEN

Laboratory Demographics

  • CLIA Code: 14D0432450
  • Facility Name: FAIRVIEW HAVEN
  • Facility Address: 605 NORTH 4TH ST
    FAIRBURY, IL
    ZIP 61739
  • Facility Phone: 815 692-2572
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: BRANDON STOLLER
  • NPI Number: 1114987161
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0432450
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name FAIRVIEW HAVEN
Street 605 NORTH 4TH ST
City FAIRBURY
State IL
ZIP 61739
Phone 815 692-2572
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 BRANDON STOLLER

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