14D2209861 CLIA NUMBER - KEMMERER VILLAGE

Laboratory Demographics

CLIA Code: 14D2209861
Facility Name: KEMMERER VILLAGE
Facility Address: 941 N 2500 EAST RD
ASSUMPTION, IL
ZIP 62510
Facility Phone: 217 226-2166
Facility Type: Other - CHILDRENS RESIDENTIAL TRT
Facility Type: Waiver
Lab Director: SCHALES L. NAGLE
NPI Number: 1811965239
Taxonomy: 322D00000X - Residential Treatment Facility, Emotionally Disturbed Children

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CLIA Record

Field Name	Field Value
CLIA Number	14D2209861
LAB Type	Other - CHILDRENS RESIDENTIAL TRT
Facility Name	KEMMERER VILLAGE
Street	941 N 2500 EAST RD
City	ASSUMPTION
State	IL
ZIP	62510
Phone	217 226-2166
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	1/18/2025
Certificate Expiration Date	1/17/2027
Facility Type	Other - CHILDRENS RESIDENTIAL TRT
Lab Director	SCHALES L. NAGLE

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