14D0436149 CLIA NUMBER - MEADOWOOD

Laboratory Demographics

  • CLIA Code: 14D0436149
  • Facility Name: MEADOWOOD
  • Facility Address: 320 SOUTH SECOND
    GRAYVILLE, IL
    ZIP 62844
  • Facility Phone: 618 375-2171
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: PATTY ETZKORN
  • NPI Number: 1871695288
  • Taxonomy: 314000000X - Skilled Nursing Facility

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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
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 PATTY ETZKORN

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