14D0711688 CLIA NUMBER - CENTRAL BAPTIST VILLAGE

Laboratory Demographics

  • CLIA Code: 14D0711688
  • Facility Name: CENTRAL BAPTIST VILLAGE
  • Facility Address: 4747 N CANFIELD AVE
    NORRIDGE, IL
    ZIP 60706
  • Facility Phone: 708 452-3700
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: KEVIN KOO
  • NPI Number: 1841292083
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0711688
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CENTRAL BAPTIST VILLAGE
Street 4747 N CANFIELD AVE
City NORRIDGE
State IL
ZIP 60706
Phone 708 452-3700
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 KEVIN KOO

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