14D1107160 CLIA NUMBER - VIVACIOUS GROUP INC

Laboratory Demographics

CLIA Number: 14D1107160

Facility Name: VIVACIOUS GROUP INC

Facility Address:
8 S 165 VINE STREET
BURR RIDGE, IL
ZIP 60527
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Facility Phone Number: 630 835-7613

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1275702888

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1107160
LAB Type	Mobile Laboratory
Facility Name	VIVACIOUS GROUP INC
Street	8 S 165 VINE STREET
City	BURR RIDGE
State	IL
ZIP	60527
Phone	630 835-7613
CertificateType	4
CertificateEffectiveDate	10/29/2023
CertificateExpirationDate	10/28/2025
FacilityType	Waiver

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