14D1066835 CLIA NUMBER - LAKE BEHAVIORAL HOSPITAL

Laboratory Demographics

  • CLIA Code: 14D1066835
  • Facility Name: LAKE BEHAVIORAL HOSPITAL
  • Facility Address: 2615 WASHINGTON ST
    WAUKEGAN, IL
    ZIP 60085
  • Facility Phone: 212 243-5565
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: GERALD CHOLEWA R N
  • NPI Number: 1134634116
  • Taxonomy: 283Q00000X - Psychiatric Hospital

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CLIA Record

Field Name Field Value
CLIA Number 14D1066835
LAB Type Hospital
Facility Name LAKE BEHAVIORAL HOSPITAL
Street 2615 WASHINGTON ST
City WAUKEGAN
State IL
ZIP 60085
Phone 212 243-5565
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2024
Certificate Expiration Date 3/6/2026
Facility Type Hospital
Lab Director GERALD CHOLEWA R N

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