14D1054063 CLIA NUMBER - RIVERSIDE FOUNDATION

Laboratory Demographics

CLIA Code: 14D1054063
Facility Name: RIVERSIDE FOUNDATION
Facility Address: 14588 HIGHWAY #22
LINCOLNSHIRE, IL
ZIP 60069
Facility Phone: 847 634-3973
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: BETTY WHITE-ZAPPA, RN
NPI Number: 1730621871
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	14D1054063
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	RIVERSIDE FOUNDATION
Street	14588 HIGHWAY #22
City	LINCOLNSHIRE
State	IL
ZIP	60069
Phone	847 634-3973
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	5/10/2024
Certificate Expiration Date	5/9/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	BETTY WHITE-ZAPPA, RN

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