14D1062278 CLIA NUMBER - PRESENCE BEHAVIORAL HEALTH

Laboratory Demographics

  • CLIA Code: 14D1062278
  • Facility Name: PRESENCE BEHAVIORAL HEALTH
  • Facility Address: 1820 S 25TH AVENUE
    BROADVIEW, IL
    ZIP 60155
  • Facility Phone: 708 410-0615
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. FONDA
  • NPI Number: 1649427774
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1062278
LAB Type Comp. Outpatient Rehab Facility
Facility Name PRESENCE BEHAVIORAL HEALTH
Street 1820 S 25TH AVENUE
City BROADVIEW
State IL
ZIP 60155
Phone 708 410-0615
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director MICHAEL J. FONDA

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