14D2285328 CLIA NUMBER - BRIGHTSIDE - OTTAWA

Laboratory Demographics

  • CLIA Code: 14D2285328
  • Facility Name: BRIGHTSIDE - OTTAWA
  • Facility Address: 408 W MAIN ST
    BRICKTON, IL
    ZIP 61350
  • Facility Phone: 602 248-8886
  • Facility Type: Other - OUTPATIENT TREATMENT PROG
  • Facility Type: Waiver
  • Lab Director: JUSTIN M. ABEYTA
  • NPI Number: 1427652809
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2285328
LAB Type Other - OUTPATIENT TREATMENT PROG
Facility Name BRIGHTSIDE - OTTAWA
Street 408 W MAIN ST
City BRICKTON
State IL
ZIP 61350
Phone 602 248-8886
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2023
Certificate Expiration Date 7/10/2025
Facility Type Other - OUTPATIENT TREATMENT PROG
Lab Director JUSTIN M. ABEYTA

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This page was last updated on: 6/4/2025