14D2221330 CLIA NUMBER - MAGNOLIA TERRACE

Laboratory Demographics

  • CLIA Code: 14D2221330
  • Facility Name: MAGNOLIA TERRACE
  • Facility Address: 623 HAMACHER
    WATERLOO, IL
    ZIP 62298
  • Facility Phone: 618 939-0500
  • Facility Type: Other - SUPPORTIVE LIVING FAC
  • Facility Type: Waiver
  • Lab Director: SUSAN R. LUTTMAN
  • NPI Number: 1457500621
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2221330
LAB Type Other - SUPPORTIVE LIVING FAC
Facility Name MAGNOLIA TERRACE
Street 623 HAMACHER
City WATERLOO
State IL
ZIP 62298
Phone 618 939-0500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Other - SUPPORTIVE LIVING FAC
Lab Director SUSAN R. LUTTMAN

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