14D2194722 CLIA NUMBER - EVERGREEN VILLAGE

Laboratory Demographics

  • CLIA Code: 14D2194722
  • Facility Name: EVERGREEN VILLAGE
  • Facility Address: 1701 EVERGREEN VILLAGE BLVD
    NORMAL, IL
    ZIP 61761
  • Facility Phone: 309 452-7300
  • Facility Type: Other - SUPPORTIVE LIVING FAC
  • Facility Type: Waiver
  • Lab Director: KRIS LOUDENBACK
  • NPI Number: 1629247283
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2194722
LAB Type Other - SUPPORTIVE LIVING FAC
Facility Name EVERGREEN VILLAGE
Street 1701 EVERGREEN VILLAGE BLVD
City NORMAL
State IL
ZIP 61761
Phone 309 452-7300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2024
Certificate Expiration Date 10/1/2026
Facility Type Other - SUPPORTIVE LIVING FAC
Lab Director KRIS LOUDENBACK

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