14D2200055 CLIA NUMBER - HERITAGE WOODS OF MANTENO

Laboratory Demographics

  • CLIA Code: 14D2200055
  • Facility Name: HERITAGE WOODS OF MANTENO
  • Facility Address: 355 DIVERSATECH DRIVE
    MANTENO, IL
    ZIP 60950
  • Facility Phone: 815 468-3553
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: BEVERLY K. FETHERLING
  • NPI Number: 1437329828
  • Taxonomy: 310400000X - Assisted Living Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2200055
LAB Type Assisted Living Facility
Facility Name HERITAGE WOODS OF MANTENO
Street 355 DIVERSATECH DRIVE
City MANTENO
State IL
ZIP 60950
Phone 815 468-3553
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2024
Certificate Expiration Date 11/12/2026
Facility Type Assisted Living Facility
Lab Director BEVERLY K. FETHERLING

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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