14D2201648 CLIA NUMBER - WALTER LAWSON CHILDREN'S HOME

Laboratory Demographics

  • CLIA Code: 14D2201648
  • Facility Name: WALTER LAWSON CHILDREN'S HOME
  • Facility Address: 1820 WALTER LAWSON DRIVE
    LOVES PARK, IL
    ZIP 61111
  • Facility Phone: 815 633-6636
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: MELISSA THORNBLOOM
  • NPI Number: 1578676391
  • Taxonomy: 3140N1450X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2201648
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name WALTER LAWSON CHILDREN'S HOME
Street 1820 WALTER LAWSON DRIVE
City LOVES PARK
State IL
ZIP 61111
Phone 815 633-6636
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/23/2024
Certificate Expiration Date 11/22/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director MELISSA THORNBLOOM

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