14D2068105 CLIA NUMBER - PRESENCE BEHAVIORAL HEALTH - 1414

Laboratory Demographics

  • CLIA Code: 14D2068105
  • Facility Name: PRESENCE BEHAVIORAL HEALTH - 1414
  • Facility Address: 1414 W MAIN ST
    MELROSE PARK, IL
    ZIP 60160
  • Facility Phone: 708 338-3806
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. FONDA
  • NPI Number: 1659527208
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2068105
LAB Type Comp. Outpatient Rehab Facility
Facility Name PRESENCE BEHAVIORAL HEALTH - 1414
Street 1414 W MAIN ST
City MELROSE PARK
State IL
ZIP 60160
Phone 708 338-3806
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Comp. Outpatient Rehab Facility
Lab Director MICHAEL J. FONDA

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