14D2212603 CLIA NUMBER - UHLICH CHILDRENS ADVANTAGE NETWORK

Laboratory Demographics

CLIA Number: 14D2212603

Facility Name: UHLICH CHILDRENS ADVANTAGE NETWORK

Facility Address:
3605 WEST FILMORE ST
CHICAGO, IL
ZIP 60624
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Facility Phone Number: 773 419-7088

Facility Type: Other - CHILDRENS HOME

Certificate Type: Waiver

NPI Number: 1356385199

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2212603
LAB Type	Other - CHILDRENS HOME
Facility Name	UHLICH CHILDRENS ADVANTAGE NETWORK
Street	3605 WEST FILMORE ST
City	CHICAGO
State	IL
ZIP	60624
Phone	773 419-7088
CertificateType	4
CertificateEffectiveDate	2/5/2023
CertificateExpirationDate	2/4/2025
FacilityType	Waiver

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