14D0894045 CLIA NUMBER - CHESTNUT HEALTH SYSTEMS

Laboratory Demographics

CLIA Number: 14D0894045

Facility Name: CHESTNUT HEALTH SYSTEMS

Facility Address:
1003 MARTIN LUTHER KING DR
BLOOMINGTON, IL
ZIP 61701
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Facility Phone Number: 618 512-1854

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1205907763

Taxonomy: 101YP2500X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	14D0894045
LAB Type	Community Clinic
Facility Name	CHESTNUT HEALTH SYSTEMS
Street	1003 MARTIN LUTHER KING DR
City	BLOOMINGTON
State	IL
ZIP	61701
Phone	618 512-1854
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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