14D0889990 CLIA NUMBER - CLARK MANOR

Laboratory Demographics

  • CLIA Code: 14D0889990
  • Facility Name: CLARK MANOR
  • Facility Address: 7433 N CLARK STREET
    CHICAGO, IL
    ZIP 60626
  • Facility Phone: 773 338-8778
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: EPIGENIA B. BACALLA
  • NPI Number: 1891740460
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0889990
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CLARK MANOR
Street 7433 N CLARK STREET
City CHICAGO
State IL
ZIP 60626
Phone 773 338-8778
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director EPIGENIA B. BACALLA

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This page was last updated on: 6/4/2025