14D2210901 CLIA NUMBER - SHELBY COUNTY COMMUNITY SERVICES

Laboratory Demographics

CLIA Number: 14D2210901

Facility Name: SHELBY COUNTY COMMUNITY SERVICES

Facility Address:
1810 WEST SOUTH 3RD ST
SHELBYVILLE, IL
ZIP 62565
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Facility Phone Number: 217 774-5587

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1801252994

Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	14D2210901
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	SHELBY COUNTY COMMUNITY SERVICES
Street	1810 WEST SOUTH 3RD ST
City	SHELBYVILLE
State	IL
ZIP	62565
Phone	217 774-5587
CertificateType	4
CertificateEffectiveDate	1/25/2023
CertificateExpirationDate	1/24/2025
FacilityType	Waiver

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