14D0888158 CLIA NUMBER - MT VERNON HEALTH CARE CENTER PETERSEN HEALTH CARE 11, INC

Laboratory Demographics

  • CLIA Code: 14D0888158
  • Facility Name: MT VERNON HEALTH CARE CENTER PETERSEN HEALTH CARE 11, INC
  • Facility Address: #5 DOCTORS PARK RD
    MOUNT VERNON, IL
    ZIP 62864
  • Facility Phone: 618 242-1064
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JAMIE M. PRANAITIS
  • NPI Number: 1780767897
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D0888158
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MT VERNON HEALTH CARE CENTER PETERSEN HEALTH CARE 11, INC
Street #5 DOCTORS PARK RD
City MOUNT VERNON
State IL
ZIP 62864
Phone 618 242-1064
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2024
Certificate Expiration Date 6/23/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JAMIE M. PRANAITIS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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