14D2023389 CLIA NUMBER - HICKORY POINT CHRISTIAN VILLAGE

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Laboratory Demographics

CLIA Number: 14D2023389

Facility Name: HICKORY POINT CHRISTIAN VILLAGE

Facility Address:
565 W MARION AVE
FORSYTH, IL
ZIP 62535
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Facility Phone Number: 217 872-5899

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1710425509

Taxonomy: 261QR0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2023389
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	HICKORY POINT CHRISTIAN VILLAGE
Street	565 W MARION AVE
City	FORSYTH
State	IL
ZIP	62535
Phone	217 872-5899
CertificateType	4
CertificateEffectiveDate	4/21/2023
CertificateExpirationDate	4/20/2025
FacilityType	Waiver

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