14D1030714 CLIA NUMBER - COTTAGE VIEW HEALTH CTR NEAR NORTH HEALTH SVC CORP

Laboratory Demographics

CLIA Number: 14D1030714

Facility Name: COTTAGE VIEW HEALTH CTR NEAR NORTH HEALTH SVC CORP

Facility Address:
4829 S COTTAGE GROVE
CHICAGO, IL
ZIP 60615
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Facility Phone Number: 773 548-1170

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1073594297

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1030714
LAB Type	Community Clinic
Facility Name	COTTAGE VIEW HEALTH CTR NEAR NORTH HEALTH SVC CORP
Street	4829 S COTTAGE GROVE
City	CHICAGO
State	IL
ZIP	60615
Phone	773 548-1170
CertificateType	3
CertificateEffectiveDate	9/14/2022
CertificateExpirationDate	9/13/2024
FacilityType	PPMP

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