14D2209406 CLIA NUMBER - BROOKSTONE ESTATES VANDALIA

Laboratory Demographics

  • CLIA Code: 14D2209406
  • Facility Name: BROOKSTONE ESTATES VANDALIA
  • Facility Address: 1607 WEST FILLMORE ST
    VANDALIA, IL
    ZIP 62471
  • Facility Phone: 618 283-9825
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: SHELLEY DOTHAGER
  • NPI Number: 1053709303
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2209406
LAB Type Assisted Living Facility
Facility Name BROOKSTONE ESTATES VANDALIA
Street 1607 WEST FILLMORE ST
City VANDALIA
State IL
ZIP 62471
Phone 618 283-9825
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2025
Certificate Expiration Date 1/12/2027
Facility Type Assisted Living Facility
Lab Director SHELLEY DOTHAGER

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