14D0993477 CLIA NUMBER - ERIE CLEMENTE WILDCATS SCHOOL BASED HEALTH CENTER

Laboratory Demographics

CLIA Number: 14D0993477

Facility Name: ERIE CLEMENTE WILDCATS SCHOOL BASED HEALTH CENTER

Facility Address:
1147 N WESTERN AVENUE
CHICAGO, IL
ZIP 60622
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Facility Phone Number: 312 666-3497

Facility Type: School/Student Health Service

Certificate Type: Microscopy

NPI Number: 1144461385

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0993477
LAB Type	School/Student Health Service
Facility Name	ERIE CLEMENTE WILDCATS SCHOOL BASED HEALTH CENTER
Street	1147 N WESTERN AVENUE
City	CHICAGO
State	IL
ZIP	60622
Phone	312 666-3497
CertificateType	3
CertificateEffectiveDate	11/15/2023
CertificateExpirationDate	11/14/2025
FacilityType	PPMP

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