15D0899296 CLIA NUMBER - CG-DSA, LLC

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CLIA Record

Field Name Field Value
CLIA Number 15D0899296
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name CG-DSA, LLC
Street 1275 MIDDLE JAMESTOWN ROAD
City LEBANON
State IN
ZIP 46052
Phone 765 482-6177
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2024
Certificate Expiration Date 4/6/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director PATRICK RATEKIN

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