14D0996865 CLIA NUMBER - ERIE JOHNSON SCHOOL BASED HEALTH CENTER

Laboratory Demographics

CLIA Number: 14D0996865

Facility Name: ERIE JOHNSON SCHOOL BASED HEALTH CENTER

Facility Address:
1504 S ALBANY
CHICAGO, IL
ZIP 60623
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Facility Phone Number: 312 432-7519

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1043407547

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0996865
LAB Type	Federally Qualified Health Center
Facility Name	ERIE JOHNSON SCHOOL BASED HEALTH CENTER
Street	1504 S ALBANY
City	CHICAGO
State	IL
ZIP	60623
Phone	312 432-7519
CertificateType	3
CertificateEffectiveDate	5/9/2024
CertificateExpirationDate	5/8/2026
FacilityType	PPMP

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