14D0906739 CLIA NUMBER - FAIRMONT CARE CENTRE

Laboratory Demographics

  • CLIA Code: 14D0906739
  • Facility Name: FAIRMONT CARE CENTRE
  • Facility Address: 5061 N PULASKI RD
    CHICAGO, IL
    ZIP 60630
  • Facility Phone: 773 604-8112
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MARIE DESCORBETH
  • NPI Number: 1861488231
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D0906739
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name FAIRMONT CARE CENTRE
Street 5061 N PULASKI RD
City CHICAGO
State IL
ZIP 60630
Phone 773 604-8112
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2023
Certificate Expiration Date 10/3/2025
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MARIE DESCORBETH

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This page was last updated on: 6/4/2025