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14D1045949 CLIA NUMBER - MEMORIAL CARE IN SULLIVAN DECATUR MEMORIAL HOSPITAL

Laboratory Demographics

CLIA Number: 14D1045949

Facility Name: MEMORIAL CARE IN SULLIVAN DECATUR MEMORIAL HOSPITAL

Facility Address:
1220 W JACKSON
SULLIVAN, IL
ZIP 61951
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Facility Phone Number: 217 728-2042

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1386277556

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name Field Value
CLIA Number 14D1045949
LAB Type Physician Office
Facility Name MEMORIAL CARE IN SULLIVAN DECATUR MEMORIAL HOSPITAL
Street 1220 W JACKSON
City SULLIVAN
State IL
ZIP 61951
Phone 217 728-2042
CertificateType 4
CertificateEffectiveDate 1/22/2023
CertificateExpirationDate 1/21/2025
FacilityType Waiver

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