14D1084258 CLIA NUMBER - LINCOLN PRAIRIE BEHAVORIAL HEALTH CTR

Laboratory Demographics

  • CLIA Code: 14D1084258
  • Facility Name: LINCOLN PRAIRIE BEHAVORIAL HEALTH CTR
  • Facility Address: 5230 S SIXTH ST RD
    SPRINGFIELD, IL
    ZIP 62703
  • Facility Phone: 217 585-1180
  • Facility Type: Other - CHILD ADOLESC PSY HOSP
  • Facility Type: Waiver
  • Lab Director: JASON DENNIS
  • NPI Number: 1033397138
  • Taxonomy: 283Q00000X - Psychiatric Hospital

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CLIA Record

Field Name Field Value
CLIA Number 14D1084258
LAB Type Other - CHILD ADOLESC PSY HOSP
Facility Name LINCOLN PRAIRIE BEHAVORIAL HEALTH CTR
Street 5230 S SIXTH ST RD
City SPRINGFIELD
State IL
ZIP 62703
Phone 217 585-1180
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2024
Certificate Expiration Date 5/19/2026
Facility Type Other - CHILD ADOLESC PSY HOSP
Lab Director JASON DENNIS

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