14D0855629 CLIA NUMBER - PCC COMMUNITY WELLNESS CENTER LAKE STREET FAMILY HEALTH CENTER

Laboratory Demographics

CLIA Number: 14D0855629

Facility Name: PCC COMMUNITY WELLNESS CENTER LAKE STREET FAMILY HEALTH CENTER

Facility Address:
14 W LAKE STREET
OAK PARK, IL
ZIP 60302
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Facility Phone Number: 708 383-0113

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1871516799

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0855629
LAB Type	Community Clinic
Facility Name	PCC COMMUNITY WELLNESS CENTER LAKE STREET FAMILY HEALTH CENTER
Street	14 W LAKE STREET
City	OAK PARK
State	IL
ZIP	60302
Phone	708 383-0113
CertificateType	3
CertificateEffectiveDate	1/31/2024
CertificateExpirationDate	1/30/2026
FacilityType	PPMP

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