14D2202507 CLIA NUMBER - HEPHZIBAH CHILDREN'S ASSOCIATION

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Laboratory Demographics

CLIA Number: 14D2202507

Facility Name: HEPHZIBAH CHILDREN'S ASSOCIATION

Facility Address:
946 N BOULEVARD
OAK PARK, IL
ZIP 60301
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Facility Phone Number: 708 649-7100

Facility Type: Other - CHILD WELFARE -RES CENTER

Certificate Type: Waiver

NPI Number: 1992767602

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2202507
LAB Type	Other - CHILD WELFARE -RES CENTER
Facility Name	HEPHZIBAH CHILDREN'S ASSOCIATION
Street	946 N BOULEVARD
City	OAK PARK
State	IL
ZIP	60301
Phone	708 649-7100
CertificateType	4
CertificateEffectiveDate	11/29/2022
CertificateExpirationDate	11/28/2024
FacilityType	Waiver

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