15D2081998 CLIA NUMBER - EVERGREEN CROSSING AND THE LOFTS

Laboratory Demographics

  • CLIA Code: 15D2081998
  • Facility Name: EVERGREEN CROSSING AND THE LOFTS
  • Facility Address: 5404 GEORGETOWN ROAD
    INDIANAPOLIS, IN
    ZIP 46254
  • Facility Phone: 317 291-5404
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MARWAN MUSTAKLEM
  • NPI Number: 1669883252
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D2081998
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name EVERGREEN CROSSING AND THE LOFTS
Street 5404 GEORGETOWN ROAD
City INDIANAPOLIS
State IN
ZIP 46254
Phone 317 291-5404
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2024
Certificate Expiration Date 8/4/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MARWAN MUSTAKLEM

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