14D0860126 CLIA NUMBER - PAVILION FOUNDATION, THE

Laboratory Demographics

  • CLIA Code: 14D0860126
  • Facility Name: PAVILION FOUNDATION, THE
  • Facility Address: 809 & 810 W CHURCH
    CHAMPAIGN, IL
    ZIP 61820
  • Facility Phone: 217 373-1700
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SMITH DEJA
  • NPI Number: 1780055608
  • Taxonomy: 283Q00000X - Psychiatric Hospital

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CLIA Record

Field Name Field Value
CLIA Number 14D0860126
LAB Type Pharmacy
Facility Name PAVILION FOUNDATION, THE
Street 809 & 810 W CHURCH
City CHAMPAIGN
State IL
ZIP 61820
Phone 217 373-1700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Pharmacy
Lab Director SMITH DEJA

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