14D1055712 CLIA NUMBER - GOOD SHEPHERD MANOR INC

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Field Name	Field Value
CLIA Number	14D1055712
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	GOOD SHEPHERD MANOR INC
Street	4129 N STATE ROUTE 1-17
City	MOMENCE
State	IL
ZIP	60954
Phone	8154723700
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/23/2024
Certificate Expiration Date	6/22/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	BRUCE R. FITZPATRICK

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This page was last updated on: 5/18/2026