14D0666602 CLIA NUMBER - COORDINATED YOUTH & HUMAN SERVICES WIC PROGRAM

Laboratory Demographics

  • CLIA Code: 14D0666602
  • Facility Name: COORDINATED YOUTH & HUMAN SERVICES WIC PROGRAM
  • Facility Address: 2016 MADISON AVENUE
    GRANITE CITY, IL
    ZIP 62040
  • Facility Phone: 618 877-3433
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: CYNTHIA A. GAVILSKY
  • NPI Number: 1639581937
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0666602
LAB Type Other
Facility Name COORDINATED YOUTH & HUMAN SERVICES WIC PROGRAM
Street 2016 MADISON AVENUE
City GRANITE CITY
State IL
ZIP 62040
Phone 618 877-3433
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 Other
Lab Director CYNTHIA A. GAVILSKY

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