14D2194770 CLIA NUMBER - EVERGREEN PLACE

Laboratory Demographics

  • CLIA Code: 14D2194770
  • Facility Name: EVERGREEN PLACE
  • Facility Address: 801 GREGORY ST
    NORMAL, IL
    ZIP 61761
  • Facility Phone: 309 451-9355
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: JOYCE BENTON
  • NPI Number: 1447429378
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2194770
LAB Type Ancillary Testing Site in Health Care Center
Facility Name EVERGREEN PLACE
Street 801 GREGORY ST
City NORMAL
State IL
ZIP 61761
Phone 309 451-9355
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 Ancillary Testing Site in Health Care Center
Lab Director JOYCE BENTON

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