14D2060852 CLIA NUMBER - FOLA COMMUNITY ACTION SERVICES INC

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Laboratory Demographics

CLIA Number: 14D2060852

Facility Name: FOLA COMMUNITY ACTION SERVICES INC

Facility Address:
8014-18 S ASHLAND AVE
CHICAGO, IL
ZIP 60620
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Facility Phone Number: 773 487-4310

Facility Type: Other - RAPID HIV TESTING

Certificate Type: Waiver

NPI Number: 1871626713

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	14D2060852
LAB Type	Other - RAPID HIV TESTING
Facility Name	FOLA COMMUNITY ACTION SERVICES INC
Street	8014-18 S ASHLAND AVE
City	CHICAGO
State	IL
ZIP	60620
Phone	773 487-4310
CertificateType	4
CertificateEffectiveDate	6/19/2023
CertificateExpirationDate	6/18/2025
FacilityType	Waiver

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