14D2133497 CLIA NUMBER - CRUSADER COMMUNITY HLTH SOUTH BELOIT JR HS

Laboratory Demographics

CLIA Number: 14D2133497

Facility Name: CRUSADER COMMUNITY HLTH SOUTH BELOIT JR HS

Facility Address:
840 BLACKHAWK BOULEVARD
SOUTH BELOIT, IL
ZIP 61080
Get Directions

Facility Phone Number: 815 490-1600

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1265601488

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2133497
LAB Type	Federally Qualified Health Center
Facility Name	CRUSADER COMMUNITY HLTH SOUTH BELOIT JR HS
Street	840 BLACKHAWK BOULEVARD
City	SOUTH BELOIT
State	IL
ZIP	61080
Phone	815 490-1600
CertificateType	4
CertificateEffectiveDate	7/13/2023
CertificateExpirationDate	7/12/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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