14D0940458 CLIA NUMBER - PCC SALUD FAMILY HEALTH

Laboratory Demographics

CLIA Number: 14D0940458

Facility Name: PCC SALUD FAMILY HEALTH

Facility Address:
5359 W FULLERTON AVE
CHICAGO, IL
ZIP 60639
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Facility Phone Number: 773 836-2785

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1487670097

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0940458
LAB Type	Federally Qualified Health Center
Facility Name	PCC SALUD FAMILY HEALTH
Street	5359 W FULLERTON AVE
City	CHICAGO
State	IL
ZIP	60639
Phone	773 836-2785
CertificateType	3
CertificateEffectiveDate	2/9/2023
CertificateExpirationDate	2/8/2025
FacilityType	PPMP

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