14D1022716 CLIA NUMBER - CRUSADER CLINIC

Laboratory Demographics

CLIA Number: 14D1022716

Facility Name: CRUSADER CLINIC

Facility Address:
1050 LOGAN AVENUE-UNIT 1 SOUTH
BELVIDERE, IL
ZIP 61008
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Facility Phone Number: (815) 547-1930

Facility Type: COMMUNITY CLINIC

Certificate Type: Waiver

NPI Number: 1780852244

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1022716
LAB Type	COMMUNITY CLINIC
Facility Name	CRUSADER CLINIC
Street	1050 LOGAN AVENUE-UNIT 1 SOUTH
City	BELVIDERE
State	IL
ZIP	61008
Phone	(815) 547-1930

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This page was last updated on: 5/11/2023