14D0433119 CLIA NUMBER - MATTOON REHAB & HCC

Laboratory Demographics

  • CLIA Code: 14D0433119
  • Facility Name: MATTOON REHAB & HCC
  • Facility Address: 2121 S 9TH ST
    MATTOON, IL
    ZIP 61938
  • Facility Phone: 217 235-7138
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: GREGORY DETERS
  • NPI Number: 1457623753
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0433119
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MATTOON REHAB & HCC
Street 2121 S 9TH ST
City MATTOON
State IL
ZIP 61938
Phone 217 235-7138
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2025
Certificate Expiration Date 8/11/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director GREGORY DETERS

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