14D0875893 CLIA NUMBER - ALDEN VILLAGE HLTH FAC FOR CHILDREN/YOUNG ADULTS

Laboratory Demographics

CLIA Number: 14D0875893

Facility Name: ALDEN VILLAGE HLTH FAC FOR CHILDREN/YOUNG ADULTS

Facility Address:
267 E LAKE ST
BLOOMINGDALE, IL
ZIP 60108
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Facility Phone Number: 630 529-3350

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1912362617

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	14D0875893
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	ALDEN VILLAGE HLTH FAC FOR CHILDREN/YOUNG ADULTS
Street	267 E LAKE ST
City	BLOOMINGDALE
State	IL
ZIP	60108
Phone	630 529-3350
CertificateType	4
CertificateEffectiveDate	5/15/2024
CertificateExpirationDate	5/14/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024