15D0919942 CLIA NUMBER - LOGAN COMMUNITY RESOURCE, INC

Laboratory Demographics

CLIA Code: 15D0919942
Facility Name: LOGAN COMMUNITY RESOURCE, INC
Facility Address: 3621 BOLAND DR CHERYL GROVES, DIRECTOR GROUP LIVING
SOUTH BEND, IN
ZIP 46628
Facility Phone: 574 289-4831
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: CHERYL A. SILVERBERG
NPI Number: 1003026642
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	15D0919942
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	LOGAN COMMUNITY RESOURCE, INC
Street	3621 BOLAND DR CHERYL GROVES, DIRECTOR GROUP LIVING
City	SOUTH BEND
State	IN
ZIP	46628
Phone	574 289-4831
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	2/14/2025
Certificate Expiration Date	2/13/2027
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	CHERYL A. SILVERBERG

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