15D0999958 CLIA NUMBER - BROOKSIDE VILLAGE HEALTH & LIVING CENTER

Laboratory Demographics

  • CLIA Code: 15D0999958
  • Facility Name: BROOKSIDE VILLAGE HEALTH & LIVING CENTER
  • Facility Address: 1111 CHURCH AVENUE
    JASPER, IN
    ZIP 47546
  • Facility Phone: 812 634-7750
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MARIAH WHITAKER
  • NPI Number: 1265419428
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D0999958
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BROOKSIDE VILLAGE HEALTH & LIVING CENTER
Street 1111 CHURCH AVENUE
City JASPER
State IN
ZIP 47546
Phone 812 634-7750
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/29/2024
Certificate Expiration Date 5/28/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MARIAH WHITAKER

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