14D0895395 CLIA NUMBER - MONTGOMERY PLACE

Laboratory Demographics

  • CLIA Code: 14D0895395
  • Facility Name: MONTGOMERY PLACE
  • Facility Address: 5550 SOUTH SHORE DRIVE
    CHICAGO, IL
    ZIP 60637
  • Facility Phone: 773 753-4096
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DANIEL BRAUNER
  • NPI Number: 1811018112
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0895395
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MONTGOMERY PLACE
Street 5550 SOUTH SHORE DRIVE
City CHICAGO
State IL
ZIP 60637
Phone 773 753-4096
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2024
Certificate Expiration Date 12/7/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director DANIEL BRAUNER

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