14D0664784 CLIA NUMBER - ERIE DIVISION STREET HEALTH CENTER

Laboratory Demographics

CLIA Number: 14D0664784

Facility Name: ERIE DIVISION STREET HEALTH CENTER

Facility Address:
2418 W DIVISION ST
CHICAGO, IL
ZIP 60622
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Facility Phone Number: 312 666-3494

Facility Type: Other

Certificate Type: Microscopy

NPI Number: 1700144243

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0664784
LAB Type	Other
Facility Name	ERIE DIVISION STREET HEALTH CENTER
Street	2418 W DIVISION ST
City	CHICAGO
State	IL
ZIP	60622
Phone	312 666-3494
CertificateType	3
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	PPMP

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