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14D0991169 CLIA NUMBER - DOBSON PLAZA

Laboratory Demographics

CLIA Number: 14D0991169

Facility Name: DOBSON PLAZA

Facility Address:
120 DODGE AVENUE
EVANSTON, IL
ZIP 60202
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Facility Phone Number: 847 869-7744

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1316232184

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name Field Value
CLIA Number 14D0991169
LAB Type Physician Office
Facility Name DOBSON PLAZA
Street 120 DODGE AVENUE
City EVANSTON
State IL
ZIP 60202
Phone 847 869-7744
CertificateType 4
CertificateEffectiveDate 9/13/2023
CertificateExpirationDate 9/12/2025
FacilityType Waiver

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