14D0672641 CLIA NUMBER - HERITAGE MANOR-MENDOTA L L C

Laboratory Demographics

CLIA Number: 14D0672641

Facility Name: HERITAGE MANOR-MENDOTA L L C

Facility Address:
1201 1ST AVENUE
MENDOTA, IL
ZIP 61342
Get Directions

Facility Phone Number: 815 539-6745

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1982948683

Taxonomy: 332BX2000X - Durable Medical Equipment & Medical Supplies

CLIA Record

Field Name	Field Value
CLIA Number	14D0672641
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	HERITAGE MANOR-MENDOTA L L C
Street	1201 1ST AVENUE
City	MENDOTA
State	IL
ZIP	61342
Phone	815 539-6745
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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