14D1032094 CLIA NUMBER - LYNWOOD ESTATES

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Field Name	Field Value
CLIA Number	14D1032094
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	LYNWOOD ESTATES
Street	301 RODDY RD
City	SALEM
State	IL
ZIP	62881
Phone	618 548-0353
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	10/18/2024
Certificate Expiration Date	10/17/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	MISTY D. WERNSMAN

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This page was last updated on: 3/20/2025