14D2172481 CLIA NUMBER - NORTHWEST HEALTHCARE L T D

Laboratory Demographics

CLIA Number: 14D2172481

Facility Name: NORTHWEST HEALTHCARE L T D

Facility Address:
5352 N LINCOLN AVE
CHICAGO, IL
ZIP 60625
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Facility Phone Number: 773 353-5047

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1235625138

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	14D2172481
LAB Type	Physician Office
Facility Name	NORTHWEST HEALTHCARE L T D
Street	5352 N LINCOLN AVE
City	CHICAGO
State	IL
ZIP	60625
Phone	773 353-5047
CertificateType	4
CertificateEffectiveDate	9/24/2023
CertificateExpirationDate	9/23/2025
FacilityType	Waiver

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