14D2308268 CLIA NUMBER - DOVER HOSPICE IL STL METRO, LLC

Laboratory Demographics

  • CLIA Code: 14D2308268
  • Facility Name: DOVER HOSPICE IL STL METRO, LLC
  • Facility Address: 2 GINGER CREEK VILLAGE
    GLEN CARBON, IL
    ZIP 62034
  • Facility Phone: 618 967-8331
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: BRANDY L. PRATT
  • NPI Number: 1629822358
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 14D2308268
LAB Type Hospice
Facility Name DOVER HOSPICE IL STL METRO, LLC
Street 2 GINGER CREEK VILLAGE
City GLEN CARBON
State IL
ZIP 62034
Phone 618 967-8331
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2024
Certificate Expiration Date 7/23/2026
Facility Type Hospice
Lab Director BRANDY L. PRATT

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