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15D0665959 CLIA NUMBER - COMMUNITY ACTION PROGRAM INC OF WESTERN INDIANA

Laboratory Demographics

CLIA Number: 15D0665959

Facility Name: COMMUNITY ACTION PROGRAM INC OF WESTERN INDIANA

Facility Address:
418 WASHINGTON STREET
COVINGTON, IN
ZIP 47932
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Facility Phone Number: 765 793-4881

Facility Type: Other - WIC-HEAD START

Certificate Type: Waiver
NPI Number: 1083829394

Taxonomy: 3747A0650X - Technician
An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law.

CLIA Record

Field Name Field Value
CLIA Number 15D0665959
LAB Type Other - WIC-HEAD START
Facility Name COMMUNITY ACTION PROGRAM INC OF WESTERN INDIANA
Street 418 WASHINGTON STREET
City COVINGTON
State IN
ZIP 47932
Phone 765 793-4881
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024