14D0888347 CLIA NUMBER - GALLATIN MANOR L L C

Laboratory Demographics

  • CLIA Code: 14D0888347
  • Facility Name: GALLATIN MANOR L L C
  • Facility Address: 900 W RACE ST
    RIDGWAY, IL
    ZIP 62979
  • Facility Phone: 618 272-8831
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ANDREA SHAW
  • NPI Number: 1497268783
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0888347
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name GALLATIN MANOR L L C
Street 900 W RACE ST
City RIDGWAY
State IL
ZIP 62979
Phone 618 272-8831
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/1/2024
Certificate Expiration Date 6/30/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director ANDREA SHAW

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