14D0956481 CLIA NUMBER - CARVER MILITARY ACADEMY SCHOOL BASED HEALTH CTR

Laboratory Demographics

CLIA Number: 14D0956481

Facility Name: CARVER MILITARY ACADEMY SCHOOL BASED HEALTH CTR

Facility Address:
13100 S DOTY AVE
CHICAGO, IL
ZIP 60827
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Facility Phone Number: 773 535-5250

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1053622043

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0956481
LAB Type	School/Student Health Service
Facility Name	CARVER MILITARY ACADEMY SCHOOL BASED HEALTH CTR
Street	13100 S DOTY AVE
City	CHICAGO
State	IL
ZIP	60827
Phone	773 535-5250
CertificateType	4
CertificateEffectiveDate	12/11/2023
CertificateExpirationDate	12/10/2025
FacilityType	Waiver

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