14D2195527 CLIA NUMBER - BROOKSTONE ESTATES OF MATTOON NORTH

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Laboratory Demographics

CLIA Number: 14D2195527

Facility Name: BROOKSTONE ESTATES OF MATTOON NORTH

Facility Address:
1920 BROOKSTONE LANE
MATTOON, IL
ZIP 61938
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Facility Phone Number: 217 235-5881

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1265820526

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	14D2195527
LAB Type	Assisted Living Facility
Facility Name	BROOKSTONE ESTATES OF MATTOON NORTH
Street	1920 BROOKSTONE LANE
City	MATTOON
State	IL
ZIP	61938
Phone	217 235-5881
CertificateType	4
CertificateEffectiveDate	10/9/2022
CertificateExpirationDate	10/8/2024
FacilityType	Waiver

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