15D0360480 CLIA NUMBER - RICHMOND STATE HOSPITAL

Laboratory Demographics

CLIA Code: 15D0360480
Facility Name: RICHMOND STATE HOSPITAL
Facility Address: 498 NW 18TH ST
RICHMOND, IN
ZIP 47374
Facility Phone: 765 966-0511
Facility Type: Hospital
Facility Type: Waiver
Lab Director: CARMELA KITCHIN
NPI Number: 1710081385
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	15D0360480
LAB Type	Hospital
Facility Name	RICHMOND STATE HOSPITAL
Street	498 NW 18TH ST
City	RICHMOND
State	IN
ZIP	47374
Phone	765 966-0511
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	7/27/2025
Certificate Expiration Date	7/26/2027
Facility Type	Hospital
Lab Director	CARMELA KITCHIN

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