14D2194605 CLIA NUMBER - EVERGREEN PLACE

Laboratory Demographics

  • CLIA Code: 14D2194605
  • Facility Name: EVERGREEN PLACE
  • Facility Address: 100 GLENHAVEN DR
    ALTON, IL
    ZIP 62002
  • Facility Phone: 618 462-1500
  • Facility Type: Other - SUPPORTIVE LIVING FAC
  • Facility Type: Waiver
  • Lab Director: LAURA ORBAN
  • NPI Number: 1013168202
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2194605
LAB Type Other - SUPPORTIVE LIVING FAC
Facility Name EVERGREEN PLACE
Street 100 GLENHAVEN DR
City ALTON
State IL
ZIP 62002
Phone 618 462-1500
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 LAURA ORBAN

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