14D2068428 CLIA NUMBER - JEFFERSON COUNTY COMPREHENSIVE SERVICES INC

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Laboratory Demographics

CLIA Number: 14D2068428

Facility Name: JEFFERSON COUNTY COMPREHENSIVE SERVICES INC

Facility Address:
16338 N IL HWY 37
MOUNT VERNON, IL
ZIP 62864
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Facility Phone Number: 618 242-1510

Facility Type: Other - DASA(DMH) LICENSED FAC

Certificate Type: Waiver

NPI Number: 1205285186

Taxonomy: 251C00000X - Day Training, Developmentally Disabled Services
These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning.

CLIA Record

Field Name	Field Value
CLIA Number	14D2068428
LAB Type	Other - DASA(DMH) LICENSED FAC
Facility Name	JEFFERSON COUNTY COMPREHENSIVE SERVICES INC
Street	16338 N IL HWY 37
City	MOUNT VERNON
State	IL
ZIP	62864
Phone	618 242-1510
CertificateType	4
CertificateEffectiveDate	11/4/2023
CertificateExpirationDate	11/3/2025
FacilityType	Waiver

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