14D0891028 CLIA NUMBER - ILLINOIS VETERANS HOME ANNA

Laboratory Demographics

CLIA Number: 14D0891028

Facility Name: ILLINOIS VETERANS HOME ANNA

Facility Address:
792 N MAIN
ANNA, IL
ZIP 62906
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Facility Phone Number: 618 833-6302

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1326105636

Taxonomy: 320700000X - Residential Treatment Facility, Physical Disabilities
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and are not able to live independently.

CLIA Record

Field Name	Field Value
CLIA Number	14D0891028
LAB Type	Physician Office
Facility Name	ILLINOIS VETERANS HOME ANNA
Street	792 N MAIN
City	ANNA
State	IL
ZIP	62906
Phone	618 833-6302
CertificateType	4
CertificateEffectiveDate	8/30/2022
CertificateExpirationDate	8/29/2024
FacilityType	Waiver

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