14D0858580 CLIA NUMBER - FONDULAC REHABILITATION & HEALTH CARE CENTER PETERSEN HEALTH OPERATIONS LLC

Laboratory Demographics

  • CLIA Code: 14D0858580
  • Facility Name: FONDULAC REHABILITATION & HEALTH CARE CENTER PETERSEN HEALTH OPERATIONS LLC
  • Facility Address: 901 ILLINI DR
    EAST PEORIA, IL
    ZIP 61611
  • Facility Phone: 309 694-6446
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SHAWNNA R. MAYER
  • NPI Number: 1548414550
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0858580
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name FONDULAC REHABILITATION & HEALTH CARE CENTER PETERSEN HEALTH OPERATIONS LLC
Street 901 ILLINI DR
City EAST PEORIA
State IL
ZIP 61611
Phone 309 694-6446
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 SHAWNNA R. MAYER

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