15D1107650 CLIA NUMBER - MOSAIC OF INDIANA

Laboratory Demographics

CLIA Code: 15D1107650
Facility Name: MOSAIC OF INDIANA
Facility Address: 204 W CLINTON STREET
GOSHEN, IN
ZIP 46528
Facility Phone: 574 675-0726
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: NATALIE KLANCER
NPI Number: 1649310194
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	15D1107650
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	MOSAIC OF INDIANA
Street	204 W CLINTON STREET
City	GOSHEN
State	IN
ZIP	46528
Phone	574 675-0726
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	11/10/2023
Certificate Expiration Date	11/9/2025
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	NATALIE KLANCER

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