14D2170586 CLIA NUMBER - GREENBAX HEALTH SOLUTIONS, LLC

Laboratory Demographics

CLIA Number: 14D2170586

Facility Name: GREENBAX HEALTH SOLUTIONS, LLC

Facility Address:
4922 W CHICAGO AVE
CHICAGO, IL
ZIP 60651
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Facility Phone Number: 773 417-3784

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1538792221

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2170586
LAB Type	Independent
Facility Name	GREENBAX HEALTH SOLUTIONS, LLC
Street	4922 W CHICAGO AVE
City	CHICAGO
State	IL
ZIP	60651
Phone	773 417-3784
CertificateType	4
CertificateEffectiveDate	8/14/2023
CertificateExpirationDate	8/13/2025
FacilityType	Waiver

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