15D0683454 CLIA NUMBER - BRICKYARD HEALTHCARE - PORTAGE CARE CENTER

Laboratory Demographics

  • CLIA Code: 15D0683454
  • Facility Name: BRICKYARD HEALTHCARE - PORTAGE CARE CENTER
  • Facility Address: 3175 LANCER ST
    PORTAGE, IN
    ZIP 46368
  • Facility Phone: 219 762-9571
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: THOMAS D. DEVINE
  • NPI Number: 1275703092
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D0683454
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BRICKYARD HEALTHCARE - PORTAGE CARE CENTER
Street 3175 LANCER ST
City PORTAGE
State IN
ZIP 46368
Phone 219 762-9571
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 THOMAS D. DEVINE

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