14D2320836 CLIA NUMBER - LIFEHOUSE BEHAVIORAL HEALTH

Laboratory Demographics

  • CLIA Code: 14D2320836
  • Facility Name: LIFEHOUSE BEHAVIORAL HEALTH
  • Facility Address: 12761 WESTERN AVE
    BLUE ISLAND, IL
    ZIP 60406
  • Facility Phone: 708 808-6678
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: DANIEL L. HOSTETLER
  • NPI Number: 1760074991
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 14D2320836
LAB Type Comp. Outpatient Rehab Facility
Facility Name LIFEHOUSE BEHAVIORAL HEALTH
Street 12761 WESTERN AVE
City BLUE ISLAND
State IL
ZIP 60406
Phone 708 808-6678
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Comp. Outpatient Rehab Facility
Lab Director DANIEL L. HOSTETLER

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