14D2071387 CLIA NUMBER - CENTERSTONE

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Laboratory Demographics

CLIA Number: 14D2071387

Facility Name: CENTERSTONE

Facility Address:
902 W MAIN ST
WEST FRANKFORT, IL
ZIP 62896
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Facility Phone Number: 618 319-4837

Facility Type: Other - DASA DMH LICENSED FAC

Certificate Type: Waiver

NPI Number: 1255647129

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2071387
LAB Type	Other - DASA DMH LICENSED FAC
Facility Name	CENTERSTONE
Street	902 W MAIN ST
City	WEST FRANKFORT
State	IL
ZIP	62896
Phone	618 319-4837
CertificateType	4
CertificateEffectiveDate	1/10/2024
CertificateExpirationDate	1/9/2026
FacilityType	Waiver

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