14D2070512 CLIA NUMBER - CHAMPAIGN BICKFORD COTTAGE

Laboratory Demographics

  • CLIA Code: 14D2070512
  • Facility Name: CHAMPAIGN BICKFORD COTTAGE
  • Facility Address: 1002 S STALEY RD
    CHAMPAIGN, IL
    ZIP 61822
  • Facility Phone: 217 403-1900
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: TIM CLARK
  • NPI Number: 1356400782
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2070512
LAB Type Assisted Living Facility
Facility Name CHAMPAIGN BICKFORD COTTAGE
Street 1002 S STALEY RD
City CHAMPAIGN
State IL
ZIP 61822
Phone 217 403-1900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2023
Certificate Expiration Date 12/17/2025
Facility Type Assisted Living Facility
Lab Director TIM CLARK

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