14D2222293 CLIA NUMBER - A & S DIVINE HEALTHCARE

Laboratory Demographics

CLIA Number: 14D2222293

Facility Name: A & S DIVINE HEALTHCARE

Facility Address:
1477 RING RD
CALUMET CITY, IL
ZIP 60409
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Facility Phone Number: 708 253-9030

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1215519038

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	14D2222293
LAB Type	Physician Office
Facility Name	A & S DIVINE HEALTHCARE
Street	1477 RING RD
City	CALUMET CITY
State	IL
ZIP	60409
Phone	708 253-9030
CertificateType	4
CertificateEffectiveDate	4/28/2023
CertificateExpirationDate	4/27/2025
FacilityType	Waiver

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