14D2254654 CLIA NUMBER - MEDMARK TREATMENT CENTERS NORMAL BLOOMINGTON-NORMAL TREATMENT CENTER, LLC

Laboratory Demographics

  • CLIA Code: 14D2254654
  • Facility Name: MEDMARK TREATMENT CENTERS NORMAL BLOOMINGTON-NORMAL TREATMENT CENTER, LLC
  • Facility Address: 303 LANDMARK DRIVE, SUITE 2-B
    NORMAL, IL
    ZIP 61761
  • Facility Phone: (309) 808-2388
  • Facility Type: Other - NARCOTIC TRMT PROGRAM
  • Facility Type: Waiver
  • Lab Director: RICHARD L. MAENZA
  • NPI Number: 1225389638
  • Taxonomy: 261QM2800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2254654
LAB Type Other - NARCOTIC TRMT PROGRAM
Facility Name MEDMARK TREATMENT CENTERS NORMAL BLOOMINGTON-NORMAL TREATMENT CENTER, LLC
Street 303 LANDMARK DRIVE, SUITE 2-B
City NORMAL
State IL
ZIP 61761
Phone 3098082388
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2026
Certificate Expiration Date 3/6/2028
Facility Type Other - NARCOTIC TRMT PROGRAM
Lab Director RICHARD L. MAENZA

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This page was last updated on: 5/18/2026