14D2299448 CLIA NUMBER - FOXES GROVE SUPPORTIVE LIVING

Laboratory Demographics

  • CLIA Code: 14D2299448
  • Facility Name: FOXES GROVE SUPPORTIVE LIVING
  • Facility Address: 395 E EDWARDSVILLE RD
    WOOD RIVER, IL
    ZIP 62095
  • Facility Phone: 618 259-0851
  • Facility Type: Other - SUPPORTIVE LIVING PROVIDE
  • Facility Type: Waiver
  • Lab Director: KAYLA M. WENTLER
  • NPI Number: 1992572184
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2299448
LAB Type Other - SUPPORTIVE LIVING PROVIDE
Facility Name FOXES GROVE SUPPORTIVE LIVING
Street 395 E EDWARDSVILLE RD
City WOOD RIVER
State IL
ZIP 62095
Phone 618 259-0851
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Other - SUPPORTIVE LIVING PROVIDE
Lab Director KAYLA M. WENTLER

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