15D0663570 CLIA NUMBER - BRICKYARD HEALTHCARE - TWELFTH STREET CARE CENTER

Laboratory Demographics

  • CLIA Code: 15D0663570
  • Facility Name: BRICKYARD HEALTHCARE - TWELFTH STREET CARE CENTER
  • Facility Address: 811 EAST 12TH ST
    MISHAWAKA, IN
    ZIP 46544
  • Facility Phone: 574 259-1917
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ORANU IBEKIE
  • NPI Number: 1851579486
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D0663570
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BRICKYARD HEALTHCARE - TWELFTH STREET CARE CENTER
Street 811 EAST 12TH ST
City MISHAWAKA
State IN
ZIP 46544
Phone 574 259-1917
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 ORANU IBEKIE

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