14D0980208 CLIA NUMBER - BENTON REHABILITATION & HEALTH CARE CENTER PETERSEN HEALTH OPERATIONS LLC

Laboratory Demographics

  • CLIA Code: 14D0980208
  • Facility Name: BENTON REHABILITATION & HEALTH CARE CENTER PETERSEN HEALTH OPERATIONS LLC
  • Facility Address: 1409 NORTH MAIN STREET- P O BOX 847
    BENTON, IL
    ZIP 62812
  • Facility Phone: 618 435-2712
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ALLYSSA JONES RN
  • NPI Number: 1316047681
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0980208
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BENTON REHABILITATION & HEALTH CARE CENTER PETERSEN HEALTH OPERATIONS LLC
Street 1409 NORTH MAIN STREET- P O BOX 847
City BENTON
State IL
ZIP 62812
Phone 618 435-2712
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2024
Certificate Expiration Date 11/13/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director ALLYSSA JONES RN

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