14D1071975 CLIA NUMBER - ALIVIO MEDICAL CENTER LITTLE VILLAGE / LAWNDALE HIGH SCHOOL

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Laboratory Demographics

CLIA Number: 14D1071975

Facility Name: ALIVIO MEDICAL CENTER LITTLE VILLAGE / LAWNDALE HIGH SCHOOL

Facility Address:
3120 SOUTH KOSTNER
CHICAGO, IL
ZIP 60623
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Facility Phone Number: 773 535-4291

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1770739591

Taxonomy: 261QS1000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1071975
LAB Type	Federally Qualified Health Center
Facility Name	ALIVIO MEDICAL CENTER LITTLE VILLAGE / LAWNDALE HIGH SCHOOL
Street	3120 SOUTH KOSTNER
City	CHICAGO
State	IL
ZIP	60623
Phone	773 535-4291
CertificateType	3
CertificateEffectiveDate	8/7/2023
CertificateExpirationDate	8/6/2025
FacilityType	PPMP

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