14D2194739 CLIA NUMBER - EVERGREEN PLACE

Laboratory Demographics

  • CLIA Code: 14D2194739
  • Facility Name: EVERGREEN PLACE
  • Facility Address: 1529 E MAIN
    STREATOR, IL
    ZIP 61364
  • Facility Phone: 815 672-0903
  • Facility Type: Other - SUPPORTIVE LIVING FAC
  • Facility Type: Waiver
  • Lab Director: KRISTIE FINNEY
  • NPI Number: 1295980852
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2194739
LAB Type Other - SUPPORTIVE LIVING FAC
Facility Name EVERGREEN PLACE
Street 1529 E MAIN
City STREATOR
State IL
ZIP 61364
Phone 815 672-0903
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 KRISTIE FINNEY

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