14D1054153 CLIA NUMBER - NEW AGE SERVICES CORPORATION

Laboratory Demographics

  • CLIA Code: 14D1054153
  • Facility Name: NEW AGE SERVICES CORPORATION
  • Facility Address: 1330 S KOSTNER AVE
    CHICAGO, IL
    ZIP 60623
  • Facility Phone: 773 542-1150
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: RICHARD H. WESLEY
  • NPI Number: 1073023149
  • Taxonomy: 261QM2800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1054153
LAB Type Comp. Outpatient Rehab Facility
Facility Name NEW AGE SERVICES CORPORATION
Street 1330 S KOSTNER AVE
City CHICAGO
State IL
ZIP 60623
Phone 773 542-1150
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2024
Certificate Expiration Date 5/14/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director RICHARD H. WESLEY

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