15D0997488 CLIA NUMBER - JAY RANDOLPH DEVELOPMENTAL SERVICES

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Field Name	Field Value
CLIA Number	15D0997488
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	JAY RANDOLPH DEVELOPMENTAL SERVICES
Street	522 E NORTH ST
City	PORTLAND
State	IN
ZIP	47371
Phone	260 726-7931
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	3/19/2024
Certificate Expiration Date	3/18/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	JAMES M. SINCLAIR

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