14D2273614 CLIA NUMBER - WILLOW RIDGE HOSPICE

Laboratory Demographics

  • CLIA Code: 14D2273614
  • Facility Name: WILLOW RIDGE HOSPICE
  • Facility Address: 536 S SCHRADER AVE
    HAVANA, IL
    ZIP 62644
  • Facility Phone: 309 338-3635
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: KYLEE DECAPP
  • NPI Number: 1972228310
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 14D2273614
LAB Type Hospice
Facility Name WILLOW RIDGE HOSPICE
Street 536 S SCHRADER AVE
City HAVANA
State IL
ZIP 62644
Phone 309 338-3635
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Hospice
Lab Director KYLEE DECAPP

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