14D0861302 CLIA NUMBER - PETERSON PARK

Laboratory Demographics

  • CLIA Code: 14D0861302
  • Facility Name: PETERSON PARK
  • Facility Address: 6141 N PULASKI
    CHICAGO, IL
    ZIP 60646
  • Facility Phone: 773 478-2000
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JOHN HURLEY
  • NPI Number: 1649276080
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0861302
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PETERSON PARK
Street 6141 N PULASKI
City CHICAGO
State IL
ZIP 60646
Phone 773 478-2000
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 JOHN HURLEY

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