14D1048026 CLIA NUMBER - KREIDER SERVICES, INC

Laboratory Demographics

CLIA Number: 14D1048026

Facility Name: KREIDER SERVICES, INC

Facility Address:
500 ANCHOR RD
DIXON, IL
ZIP 61021
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Facility Phone Number: 815 288-6691

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1295067247

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	14D1048026
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	KREIDER SERVICES, INC
Street	500 ANCHOR RD
City	DIXON
State	IL
ZIP	61021
Phone	815 288-6691
CertificateType	4
CertificateEffectiveDate	11/21/2023
CertificateExpirationDate	11/20/2025
FacilityType	Waiver

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