14D0870126 CLIA NUMBER - CISNE REHABILITATION & HEALTH CARE PETERSEN HEALTH OPERATIONS LLC

Laboratory Demographics

  • CLIA Code: 14D0870126
  • Facility Name: CISNE REHABILITATION & HEALTH CARE PETERSEN HEALTH OPERATIONS LLC
  • Facility Address: 107 N WATKINS STREET
    CISNE, IL
    ZIP 62823
  • Facility Phone: 618 673-2177
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: TOMMY R. PORTER
  • NPI Number: 1225071442
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0870126
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CISNE REHABILITATION & HEALTH CARE PETERSEN HEALTH OPERATIONS LLC
Street 107 N WATKINS STREET
City CISNE
State IL
ZIP 62823
Phone 618 673-2177
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 TOMMY R. PORTER

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