14D0433511 CLIA NUMBER - BEVERLY FARM FOUNDATION

Laboratory Demographics

  • CLIA Code: 14D0433511
  • Facility Name: BEVERLY FARM FOUNDATION
  • Facility Address: 6301 HUMBERT RD
    GODFREY, IL
    ZIP 62035
  • Facility Phone: 618 466-0367
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: SANDRA A. CHADDUCK
  • NPI Number: 1255885414
  • Taxonomy: 251C00000X - Day Training, Developmentally Disabled Services

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CLIA Record

Field Name Field Value
CLIA Number 14D0433511
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name BEVERLY FARM FOUNDATION
Street 6301 HUMBERT RD
City GODFREY
State IL
ZIP 62035
Phone 618 466-0367
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 Intermediate Care Facility for Mentally Retarded
Lab Director SANDRA A. CHADDUCK

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