14D2128317 CLIA NUMBER - MAPLE CREEK HOSPICE

Laboratory Demographics

CLIA Number: 14D2128317

Facility Name: MAPLE CREEK HOSPICE

Facility Address:
706 S ST LOUIS ST
SPARTA, IL
ZIP 62286
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Facility Phone Number: 618 443-4671

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1477007458

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	14D2128317
LAB Type	Hospice
Facility Name	MAPLE CREEK HOSPICE
Street	706 S ST LOUIS ST
City	SPARTA
State	IL
ZIP	62286
Phone	618 443-4671
CertificateType	4
CertificateEffectiveDate	3/28/2023
CertificateExpirationDate	3/27/2025
FacilityType	Waiver

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