14D0432568 CLIA NUMBER - EVENGLOW LODGE

Laboratory Demographics

  • CLIA Code: 14D0432568
  • Facility Name: EVENGLOW LODGE
  • Facility Address: 215 E WASHINGTON
    PONTIAC, IL
    ZIP 61764
  • Facility Phone: 815 844-6131
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SHEILA K. SIMONS
  • NPI Number: 1558314302
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0432568
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name EVENGLOW LODGE
Street 215 E WASHINGTON
City PONTIAC
State IL
ZIP 61764
Phone 815 844-6131
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 SHEILA K. SIMONS

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