15D1062891 CLIA NUMBER - BLOOM AT KOKOMO

Laboratory Demographics

  • CLIA Code: 15D1062891
  • Facility Name: BLOOM AT KOKOMO
  • Facility Address: 2800 S DIXON RD
    KOKOMO, IN
    ZIP 46902
  • Facility Phone: 765 455-2828
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: GARY BRENT WAYMIRE
  • NPI Number: 1366904872
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D1062891
LAB Type Assisted Living Facility
Facility Name BLOOM AT KOKOMO
Street 2800 S DIXON RD
City KOKOMO
State IN
ZIP 46902
Phone 765 455-2828
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/29/2024
Certificate Expiration Date 12/28/2026
Facility Type Assisted Living Facility
Lab Director GARY BRENT WAYMIRE

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