14D1006174 CLIA NUMBER - LOUISE LANDAU HEALTH CENTER NEAR NORTH HEALTH SERVICE CORPORATION

Laboratory Demographics

CLIA Number: 14D1006174

Facility Name: LOUISE LANDAU HEALTH CENTER NEAR NORTH HEALTH SERVICE CORPORATION

Facility Address:
800 N KEDZIE AVE
CHICAGO, IL
ZIP 60651
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Facility Phone Number: 312 337-1073

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1831170059

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1006174
LAB Type	Community Clinic
Facility Name	LOUISE LANDAU HEALTH CENTER NEAR NORTH HEALTH SERVICE CORPORATION
Street	800 N KEDZIE AVE
City	CHICAGO
State	IL
ZIP	60651
Phone	312 337-1073
CertificateType	3
CertificateEffectiveDate	11/12/2022
CertificateExpirationDate	11/11/2024
FacilityType	PPMP

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