14D2309577 CLIA NUMBER - PROVIDENCE FARM, LLC

Laboratory Demographics

  • CLIA Code: 14D2309577
  • Facility Name: PROVIDENCE FARM, LLC
  • Facility Address: 479 LEE ST
    NORTHBROOK, IL
    ZIP 60062
  • Facility Phone: 847 409-6230
  • Facility Type: Other - TRANSITIONAL LIVING SOBER
  • Facility Type: Waiver
  • Lab Director: STEPHANIE ZWILLING
  • NPI Number: 1518790559
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D2309577
LAB Type Other - TRANSITIONAL LIVING SOBER
Facility Name PROVIDENCE FARM, LLC
Street 479 LEE ST
City NORTHBROOK
State IL
ZIP 60062
Phone 847 409-6230
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2024
Certificate Expiration Date 8/18/2026
Facility Type Other - TRANSITIONAL LIVING SOBER
Lab Director STEPHANIE ZWILLING

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