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14D2195449 CLIA NUMBER - VICTORIAN INN

Laboratory Demographics

CLIA Number: 14D2195449

Facility Name: VICTORIAN INN

Facility Address:
12600 RENAISSANCE CIRCLE
HOMER GLEN, IL
ZIP 60491
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Facility Phone Number: 708 301-0800

Facility Type: Assisted Living Facility

Certificate Type: Waiver
NPI Number: 1629476056

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name Field Value
CLIA Number 14D2195449
LAB Type Assisted Living Facility
Facility Name VICTORIAN INN
Street 12600 RENAISSANCE CIRCLE
City HOMER GLEN
State IL
ZIP 60491
Phone 708 301-0800
CertificateType 4
CertificateEffectiveDate 10/8/2022
CertificateExpirationDate 10/7/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024