14D2169705 CLIA NUMBER - NEURORESTORATIVE CYPRESS CARBONDALE

Laboratory Demographics

  • CLIA Code: 14D2169705
  • Facility Name: NEURORESTORATIVE CYPRESS CARBONDALE
  • Facility Address: 2500 E WALNUT ST
    CARBONDALE, IL
    ZIP 62901
  • Facility Phone: 618 529-3060
  • Facility Type: Other - COMM BASED RES REHAB CTR
  • Facility Type: Waiver
  • Lab Director: MICHELLE VAUGHN
  • NPI Number: 1154669646
  • Taxonomy: 283X00000X - Rehabilitation Hospital

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CLIA Record

Field Name Field Value
CLIA Number 14D2169705
LAB Type Other - COMM BASED RES REHAB CTR
Facility Name NEURORESTORATIVE CYPRESS CARBONDALE
Street 2500 E WALNUT ST
City CARBONDALE
State IL
ZIP 62901
Phone 618 529-3060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/25/2025
Certificate Expiration Date 7/24/2027
Facility Type Other - COMM BASED RES REHAB CTR
Lab Director MICHELLE VAUGHN

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