14D2205036 CLIA NUMBER - GREENFIELD HOME ADELINE E PROUTY TRUST

Laboratory Demographics

  • CLIA Code: 14D2205036
  • Facility Name: GREENFIELD HOME ADELINE E PROUTY TRUST
  • Facility Address: 508 PARK AVE EAST
    PRINCETON, IL
    ZIP 61356
  • Facility Phone: 815 872-2261
  • Facility Type: Other - LICENSED SHELTER CARE
  • Facility Type: Waiver
  • Lab Director: SHELLY A. DAVIS
  • NPI Number: 1013124593
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2205036
LAB Type Other - LICENSED SHELTER CARE
Facility Name GREENFIELD HOME ADELINE E PROUTY TRUST
Street 508 PARK AVE EAST
City PRINCETON
State IL
ZIP 61356
Phone 815 872-2261
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Other - LICENSED SHELTER CARE
Lab Director SHELLY A. DAVIS

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