14D0646710 CLIA NUMBER - MAPLE CREST CARE CENTRE

Laboratory Demographics

  • CLIA Code: 14D0646710
  • Facility Name: MAPLE CREST CARE CENTRE
  • Facility Address: 4452 SQUAW PRAIRIE RD
    BELVIDERE, IL
    ZIP 61008
  • Facility Phone: (815) 547-6377
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: THOMAS MICHALSEN MD
  • NPI Number: 1649256876
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0646710
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MAPLE CREST CARE CENTRE
Street 4452 SQUAW PRAIRIE RD
City BELVIDERE
State IL
ZIP 61008
Phone 8155476377
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 THOMAS MICHALSEN MD

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This page was last updated on: 5/18/2026