14D2254951 CLIA NUMBER - ELEMENTAL CENTER

Laboratory Demographics

  • CLIA Code: 14D2254951
  • Facility Name: ELEMENTAL CENTER
  • Facility Address: 612 S WESTERN AVE - UNIT 1
    CHICAGO, IL
    ZIP 60612
  • Facility Phone: 708 364-0580
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARTINS ADEOYE
  • NPI Number: 1740793074
  • Taxonomy: 2084B0040X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 14D2254951
LAB Type Physician Office
Facility Name ELEMENTAL CENTER
Street 612 S WESTERN AVE - UNIT 1
City CHICAGO
State IL
ZIP 60612
Phone 708 364-0580
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2024
Certificate Expiration Date 3/8/2026
Facility Type Physician Office
Lab Director MARTINS ADEOYE

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