14D0960130 CLIA NUMBER - PROFESSIONAL HOME CARE ADVANTAGE INC

Laboratory Demographics

  • CLIA Code: 14D0960130
  • Facility Name: PROFESSIONAL HOME CARE ADVANTAGE INC
  • Facility Address: 2521 RIDGE RD, STE 1
    LANSING, IL
    ZIP 60438
  • Facility Phone: 708 979-0932
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: RAPHAEL OGOM
  • NPI Number: 1801845896
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 14D0960130
LAB Type Home Health Agency
Facility Name PROFESSIONAL HOME CARE ADVANTAGE INC
Street 2521 RIDGE RD, STE 1
City LANSING
State IL
ZIP 60438
Phone 708 979-0932
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Home Health Agency
Lab Director RAPHAEL OGOM

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