14D2214321 CLIA NUMBER - JO DAVIESS COUNTY JAIL

Laboratory Demographics

CLIA Number: 14D2214321

Facility Name: JO DAVIESS COUNTY JAIL

Facility Address:
330 N BENCH ST
GALENA, IL
ZIP 61036
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Facility Phone Number: 815 777-2141

Facility Type: Prison

Certificate Type: Waiver

NPI Number: 1871683110

Taxonomy: 251K00000X - Public Health or Welfare

CLIA Record

Field Name	Field Value
CLIA Number	14D2214321
LAB Type	Prison
Facility Name	JO DAVIESS COUNTY JAIL
Street	330 N BENCH ST
City	GALENA
State	IL
ZIP	61036
Phone	815 777-2141
CertificateType	4
CertificateEffectiveDate	2/22/2023
CertificateExpirationDate	2/21/2025
FacilityType	Waiver

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