15D0351997 CLIA NUMBER - PROVIDENCE ANDERSON

Laboratory Demographics

  • CLIA Code: 15D0351997
  • Facility Name: PROVIDENCE ANDERSON
  • Facility Address: 1345 N MADISON AVE
    ANDERSON, IN
    ZIP 46011
  • Facility Phone: 765 644-2888
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: AMBER STEWART
  • NPI Number: 1790158335
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D0351997
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PROVIDENCE ANDERSON
Street 1345 N MADISON AVE
City ANDERSON
State IN
ZIP 46011
Phone 765 644-2888
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 AMBER STEWART

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