14D0869007 CLIA NUMBER - JERSEYVILLE MANOR

Laboratory Demographics

  • CLIA Code: 14D0869007
  • Facility Name: JERSEYVILLE MANOR
  • Facility Address: 1251 N STATE
    JERSEYVILLE, IL
    ZIP 62052
  • Facility Phone: 618 498-6441
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MATT K. HAILS
  • NPI Number: 1336428937
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0869007
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name JERSEYVILLE MANOR
Street 1251 N STATE
City JERSEYVILLE
State IL
ZIP 62052
Phone 618 498-6441
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 MATT K. HAILS

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