15D1009011 CLIA NUMBER - KINGSTON AT DUPONT

Laboratory Demographics

  • CLIA Code: 15D1009011
  • Facility Name: KINGSTON AT DUPONT
  • Facility Address: 1716 E DUPONT RD
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 260 490-5111
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: CAROLYN Y. DAVIDSON
  • NPI Number: 1932196177
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D1009011
LAB Type Other
Facility Name KINGSTON AT DUPONT
Street 1716 E DUPONT RD
City FORT WAYNE
State IN
ZIP 46825
Phone 260 490-5111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2025
Certificate Expiration Date 2/3/2027
Facility Type Other
Lab Director CAROLYN Y. DAVIDSON

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