14D0646796 CLIA NUMBER - ROSEVILLE REHABILITATION & HEALTH CARE PETERSEN HEALTH CARE - ROSEVILLE, LLC

Laboratory Demographics

  • CLIA Code: 14D0646796
  • Facility Name: ROSEVILLE REHABILITATION & HEALTH CARE PETERSEN HEALTH CARE - ROSEVILLE, LLC
  • Facility Address: 145 S CHAMBERLAIN
    ROSEVILLE, IL
    ZIP 61473
  • Facility Phone: 309 426-2134
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: KIM D. WYNKOOP
  • NPI Number: 1225079684
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0646796
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name ROSEVILLE REHABILITATION & HEALTH CARE PETERSEN HEALTH CARE - ROSEVILLE, LLC
Street 145 S CHAMBERLAIN
City ROSEVILLE
State IL
ZIP 61473
Phone 309 426-2134
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 KIM D. WYNKOOP

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