14D1078925 CLIA NUMBER - CENTER ON HALSTED

Laboratory Demographics

  • CLIA Code: 14D1078925
  • Facility Name: CENTER ON HALSTED
  • Facility Address: 3656 N HALSTED
    CHICAGO, IL
    ZIP 60613
  • Facility Phone: (773) 472-6469
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: MODESTO VALLE
  • NPI Number: 1508824244
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1078925
LAB Type Other
Facility Name CENTER ON HALSTED
Street 3656 N HALSTED
City CHICAGO
State IL
ZIP 60613
Phone 7734726469
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/18/2026
Certificate Expiration Date 1/17/2028
Facility Type Other
Lab Director MODESTO VALLE

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