14D2141446 CLIA NUMBER - TRANSFORMATIVE HEALTHCARE, LLC

Laboratory Demographics

  • CLIA Code: 14D2141446
  • Facility Name: TRANSFORMATIVE HEALTHCARE, LLC
  • Facility Address: 4 COUNTRY CLUB EXECUTIVE PARK
    GLEN CARBON, IL
    ZIP 62034
  • Facility Phone: 573 268-7300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALISHA A. WHITE MD
  • NPI Number: 1548639255
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 14D2141446
LAB Type Physician Office
Facility Name TRANSFORMATIVE HEALTHCARE, LLC
Street 4 COUNTRY CLUB EXECUTIVE PARK
City GLEN CARBON
State IL
ZIP 62034
Phone 573 268-7300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2023
Certificate Expiration Date 12/12/2025
Facility Type Physician Office
Lab Director ALISHA A. WHITE MD

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