15D1037082 CLIA NUMBER - WHITLOCK PLACE

Laboratory Demographics

CLIA Number: 15D1037082

Facility Name: WHITLOCK PLACE

Facility Address:
1719 S ELM ST
CRAWFORDSVILLE, IN
ZIP 47933
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Facility Phone Number: 765 364-1880

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1487849063

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	15D1037082
LAB Type	Assisted Living Facility
Facility Name	WHITLOCK PLACE
Street	1719 S ELM ST
City	CRAWFORDSVILLE
State	IN
ZIP	47933
Phone	765 364-1880
CertificateType	4
CertificateEffectiveDate	2/15/2023
CertificateExpirationDate	2/14/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024