14D2322154 CLIA NUMBER - GRACE MODERN HEALTH PC

Laboratory Demographics

  • CLIA Code: 14D2322154
  • Facility Name: GRACE MODERN HEALTH PC
  • Facility Address: 1121 E MAIN ST - STE 122
    ST CHARLES, IL
    ZIP 60174
  • Facility Phone: 908 930-0052
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: GRACE CABANILLAS
  • NPI Number: 1306613997
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2322154
LAB Type Practitioner Other
Facility Name GRACE MODERN HEALTH PC
Street 1121 E MAIN ST - STE 122
City ST CHARLES
State IL
ZIP 60174
Phone 908 930-0052
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2025
Certificate Expiration Date 4/15/2027
Facility Type Practitioner Other
Lab Director GRACE CABANILLAS

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