14D2194518 CLIA NUMBER - EVERGREEN SENIOR LIVING

Laboratory Demographics

  • CLIA Code: 14D2194518
  • Facility Name: EVERGREEN SENIOR LIVING
  • Facility Address: 4825 E EVERGREEN CT
    DECATUR, IL
    ZIP 62521
  • Facility Phone: 217 864-4300
  • Facility Type: Other - SUPPORTIVE LIVING FAC
  • Facility Type: Waiver
  • Lab Director: JOHNA MCFADDEN
  • NPI Number: 1003188913
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2194518
LAB Type Other - SUPPORTIVE LIVING FAC
Facility Name EVERGREEN SENIOR LIVING
Street 4825 E EVERGREEN CT
City DECATUR
State IL
ZIP 62521
Phone 217 864-4300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Other - SUPPORTIVE LIVING FAC
Lab Director JOHNA MCFADDEN

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