14D1023471 CLIA NUMBER - ENTERA HEALTHCARE SOUTH PRODIGY HOME CARE INC

Laboratory Demographics

  • CLIA Code: 14D1023471
  • Facility Name: ENTERA HEALTHCARE SOUTH PRODIGY HOME CARE INC
  • Facility Address: 1010 JORIE BLVD - STE 34
    OAK BROOK, IL
    ZIP 60523
  • Facility Phone: 708 444-4027
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: EDEN TAGAYUNA
  • NPI Number: 1295781862
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 14D1023471
LAB Type Home Health Agency
Facility Name ENTERA HEALTHCARE SOUTH PRODIGY HOME CARE INC
Street 1010 JORIE BLVD - STE 34
City OAK BROOK
State IL
ZIP 60523
Phone 708 444-4027
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2024
Certificate Expiration Date 3/16/2026
Facility Type Home Health Agency
Lab Director EDEN TAGAYUNA

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This page was last updated on: 9/29/2025