15D0945111 CLIA NUMBER - TRAIL CREEK PLACE, LLC

Laboratory Demographics

  • CLIA Code: 15D0945111
  • Facility Name: TRAIL CREEK PLACE, LLC
  • Facility Address: 1300 E COOLSPRING AVE
    MICHIGAN CITY, IN
    ZIP 46360
  • Facility Phone: 260 312-8082
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: RENITA VLASEK
  • NPI Number: 1861205817
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D0945111
LAB Type Assisted Living Facility
Facility Name TRAIL CREEK PLACE, LLC
Street 1300 E COOLSPRING AVE
City MICHIGAN CITY
State IN
ZIP 46360
Phone 260 312-8082
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2024
Certificate Expiration Date 4/23/2026
Facility Type Assisted Living Facility
Lab Director RENITA VLASEK

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