14D2190051 CLIA NUMBER - PRENTICE PLACE

Laboratory Demographics

  • CLIA Code: 14D2190051
  • Facility Name: PRENTICE PLACE
  • Facility Address: 255 W 112TH PLACE
    CHICAGO, IL
    ZIP 60628
  • Facility Phone: 773 391-3123
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: PRENTICE EARL
  • NPI Number: 1548774961
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2190051
LAB Type Assisted Living Facility
Facility Name PRENTICE PLACE
Street 255 W 112TH PLACE
City CHICAGO
State IL
ZIP 60628
Phone 773 391-3123
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Assisted Living Facility
Lab Director PRENTICE EARL

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