14D2194874 CLIA NUMBER - THE LODGE AT MANITO

Laboratory Demographics

  • CLIA Code: 14D2194874
  • Facility Name: THE LODGE AT MANITO
  • Facility Address: 1303 S EAST AVE
    MANITO, IL
    ZIP 61546
  • Facility Phone: 309 968-5330
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JESSICA L. TOWERY
  • NPI Number: 1457127409
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2194874
LAB Type Assisted Living Facility
Facility Name THE LODGE AT MANITO
Street 1303 S EAST AVE
City MANITO
State IL
ZIP 61546
Phone 309 968-5330
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/5/2024
Certificate Expiration Date 10/4/2026
Facility Type Assisted Living Facility
Lab Director JESSICA L. TOWERY

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