15D0360348 CLIA NUMBER - PERSIMMON RIDGE REHAB CENTRE

Laboratory Demographics

  • CLIA Code: 15D0360348
  • Facility Name: PERSIMMON RIDGE REHAB CENTRE
  • Facility Address: 200 N PARK ST
    PORTLAND, IN
    ZIP 47371
  • Facility Phone: 260 726-9355
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MELINDA SUE HODGSON
  • NPI Number: 1811196843
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D0360348
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PERSIMMON RIDGE REHAB CENTRE
Street 200 N PARK ST
City PORTLAND
State IN
ZIP 47371
Phone 260 726-9355
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 MELINDA SUE HODGSON

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