14D2210990 CLIA NUMBER - OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER INC

Laboratory Demographics

CLIA Number: 14D2210990

Facility Name: OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER INC

Facility Address:
1718 N 2525TH RD
OTTAWA, IL
ZIP 61350
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Facility Phone Number: 815 434-0737

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1477958528

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	14D2210990
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	OTTAWA FRIENDSHIP HOUSE WORK ACTIVITY CENTER INC
Street	1718 N 2525TH RD
City	OTTAWA
State	IL
ZIP	61350
Phone	815 434-0737
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