14D2037813 CLIA NUMBER - FAMILY CARE PARTNERS INC

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Laboratory Demographics

CLIA Number: 14D2037813

Facility Name: FAMILY CARE PARTNERS INC

Facility Address:
6625 S PULASKI RD
CHICAGO, IL
ZIP 60629
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Facility Phone Number: 773 375-3312

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1861795486

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2037813
LAB Type	Physician Office
Facility Name	FAMILY CARE PARTNERS INC
Street	6625 S PULASKI RD
City	CHICAGO
State	IL
ZIP	60629
Phone	773 375-3312
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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