14D0436149 CLIA NUMBER - MEADOWOOD

Laboratory Demographics

CLIA Number: 14D0436149

Facility Name: MEADOWOOD

Facility Address:
320 SOUTH SECOND
GRAYVILLE, IL
ZIP 62844
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Facility Phone Number: 618 375-2171

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1871695288

Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

CLIA Record

Field Name	Field Value
CLIA Number	14D0436149
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	MEADOWOOD
Street	320 SOUTH SECOND
City	GRAYVILLE
State	IL
ZIP	62844
Phone	618 375-2171
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024