14D2008104 CLIA NUMBER - HAWTHORN BEHAVORIAL HEALTH

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Laboratory Demographics

CLIA Number: 14D2008104

Facility Name: HAWTHORN BEHAVORIAL HEALTH

Facility Address:
200 S GREENLEAF ST, STE J
GURNEE, IL
ZIP 60031
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Facility Phone Number: 847 672-6478

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366768772

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2008104
LAB Type	Physician Office
Facility Name	HAWTHORN BEHAVORIAL HEALTH
Street	200 S GREENLEAF ST, STE J
City	GURNEE
State	IL
ZIP	60031
Phone	847 672-6478
CertificateType	4
CertificateEffectiveDate	6/4/2022
CertificateExpirationDate	6/3/2024
FacilityType	Waiver

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