14D0646794 CLIA NUMBER - COUNTRYSIDE CARE CENTER LLC

Laboratory Demographics

  • CLIA Code: 14D0646794
  • Facility Name: COUNTRYSIDE CARE CENTER LLC
  • Facility Address: 400 W GRANT ST
    MACOMB, IL
    ZIP 61455
  • Facility Phone: 845 414-3300
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: CHAIM MILLMAN
  • NPI Number: 1841444601
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0646794
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name COUNTRYSIDE CARE CENTER LLC
Street 400 W GRANT ST
City MACOMB
State IL
ZIP 61455
Phone 845 414-3300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2025
Certificate Expiration Date 5/4/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director CHAIM MILLMAN

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