14D0966815 CLIA NUMBER - CENTER FOR HEALTHY LIFESTYLES

Laboratory Demographics

CLIA Code: 14D0966815
Facility Name: CENTER FOR HEALTHY LIFESTYLES
Facility Address: 2200 E WASHINGTON STREET
BLOOMINGTON, IL
ZIP 61701
Facility Phone: 309 661-5153
Facility Type: Ancillary Testing Site in Health Care Center
Facility Type: Waiver
Lab Director: PAUL PEDERSEN MD
NPI Number: 1265187363
Taxonomy: 322D00000X - Residential Treatment Facility, Emotionally Disturbed Children

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CLIA Record

Field Name	Field Value
CLIA Number	14D0966815
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	CENTER FOR HEALTHY LIFESTYLES
Street	2200 E WASHINGTON STREET
City	BLOOMINGTON
State	IL
ZIP	61701
Phone	309 661-5153
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	10/26/2023
Certificate Expiration Date	10/25/2025
Facility Type	Ancillary Testing Site in Health Care Center
Lab Director	PAUL PEDERSEN MD

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