14D1107160 CLIA NUMBER - VIVACIOUS GROUP INC

Laboratory Demographics

  • CLIA Code: 14D1107160
  • Facility Name: VIVACIOUS GROUP INC
  • Facility Address: 8 S 165 VINE STREET
    BURR RIDGE, IL
    ZIP 60527
  • Facility Phone: 630 835-7613
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: ANTO MALIAKKAL
  • NPI Number: 1275702888
  • Taxonomy: 261QP2300X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2023
Certificate Expiration Date 10/28/2025
Facility Type Mobile Laboratory
Lab Director ANTO MALIAKKAL

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