14D0882108 CLIA NUMBER - ILLINOIS DEPARTMENT OF CORRECTIONS HEALTH SERVICES ADMINISTRATION

Laboratory Demographics

  • CLIA Code: 14D0882108
  • Facility Name: ILLINOIS DEPARTMENT OF CORRECTIONS HEALTH SERVICES ADMINISTRATION
  • Facility Address: 100 WEST RANDOLPH STREET SUITE 4-200
    CHICAGO, IL
    ZIP 60601
  • Facility Phone: 312 814-5786
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: DANIEL S. TOWNE
  • NPI Number: 1760966675
  • Taxonomy: 251B00000X - Case Management

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CLIA Record

Field Name Field Value
CLIA Number 14D0882108
LAB Type Prison
Facility Name ILLINOIS DEPARTMENT OF CORRECTIONS HEALTH SERVICES ADMINISTRATION
Street 100 WEST RANDOLPH STREET SUITE 4-200
City CHICAGO
State IL
ZIP 60601
Phone 312 814-5786
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2024
Certificate Expiration Date 1/27/2026
Facility Type Prison
Lab Director DANIEL S. TOWNE

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This page was last updated on: 3/20/2025