14D2192146 CLIA NUMBER - CRAIN DIAGNOSTICS, PLLC

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Laboratory Demographics

CLIA Number: 14D2192146

Facility Name: CRAIN DIAGNOSTICS, PLLC

Facility Address:
17066 S SOUTH PARK
SOUTH HOLLAND, IL
ZIP 60473
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Facility Phone Number: 708 882-0532

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1740952217

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2192146
LAB Type	Practitioner Other
Facility Name	CRAIN DIAGNOSTICS, PLLC
Street	17066 S SOUTH PARK
City	SOUTH HOLLAND
State	IL
ZIP	60473
Phone	708 882-0532
CertificateType	4
CertificateEffectiveDate	9/4/2022
CertificateExpirationDate	9/3/2024
FacilityType	Waiver

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