14D1055645 CLIA NUMBER - PILSEN LITTLE VILLAGE COMMUNITY MENTAL HEALTH CTR

Laboratory Demographics

CLIA Number: 14D1055645

Facility Name: PILSEN LITTLE VILLAGE COMMUNITY MENTAL HEALTH CTR

Facility Address:
3113 WEST CERMAK ROAD
CHICAGO, IL
ZIP 60623
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Facility Phone Number: 773 277-3413

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1073781811

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1055645
LAB Type	Other
Facility Name	PILSEN LITTLE VILLAGE COMMUNITY MENTAL HEALTH CTR
Street	3113 WEST CERMAK ROAD
City	CHICAGO
State	IL
ZIP	60623
Phone	773 277-3413
CertificateType	4
CertificateEffectiveDate	6/22/2022
CertificateExpirationDate	6/21/2024
FacilityType	Waiver

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