16D0673461 CLIA NUMBER - PAVILION OF OTTAWA

Laboratory Demographics

  • CLIA Code: 16D0673461
  • Facility Name: PAVILION OF OTTAWA
  • Facility Address: 704 E GLOVER
    OTTAWA, IL
    ZIP 61350
  • Facility Phone: 815 431-4900
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: LAUREN MATTES
  • NPI Number: 1205813490
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 16D0673461
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PAVILION OF OTTAWA
Street 704 E GLOVER
City OTTAWA
State IL
ZIP 61350
Phone 815 431-4900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director LAUREN MATTES

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