15D1032017 CLIA NUMBER - INDIANA MENTOR

Laboratory Demographics

  • CLIA Code: 15D1032017
  • Facility Name: INDIANA MENTOR
  • Facility Address: 8777 PURDUE ROAD SUITE 300
    INDIANAPOLIS, IN
    ZIP 46268
  • Facility Phone: 317 581-2380
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: ELIZABETH NELSON
  • NPI Number: 1124349048
  • Taxonomy: 253J00000X - Foster Care Agency

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CLIA Record

Field Name Field Value
CLIA Number 15D1032017
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name INDIANA MENTOR
Street 8777 PURDUE ROAD SUITE 300
City INDIANAPOLIS
State IN
ZIP 46268
Phone 317 581-2380
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2024
Certificate Expiration Date 10/14/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director ELIZABETH NELSON

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