14D1082994 CLIA NUMBER - NEURORESTORATIVE CARBONDALE - CARDINAL

Laboratory Demographics

CLIA Code: 14D1082994
Facility Name: NEURORESTORATIVE CARBONDALE - CARDINAL
Facility Address: 1271 A E WALNUT ST
CARBONDALE, IL
ZIP 62901
Facility Phone: 618 529-3978
Facility Type: Other
Facility Type: Waiver
Lab Director: MICHELLE VAUGHN
NPI Number: 1912487976
Taxonomy: 322D00000X - Residential Treatment Facility, Emotionally Disturbed Children

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CLIA Record

Field Name	Field Value
CLIA Number	14D1082994
LAB Type	Other
Facility Name	NEURORESTORATIVE CARBONDALE - CARDINAL
Street	1271 A E WALNUT ST
City	CARBONDALE
State	IL
ZIP	62901
Phone	618 529-3978
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	4/23/2024
Certificate Expiration Date	4/22/2026
Facility Type	Other
Lab Director	MICHELLE VAUGHN

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