15D2096053 CLIA NUMBER - ALLISONVILLE

Laboratory Demographics

  • CLIA Code: 15D2096053
  • Facility Name: ALLISONVILLE
  • Facility Address: 5011 ALLISONVILLE ROAD
    INDIANAPOLIS, IN
    ZIP 46205
  • Facility Phone: 317 258-6041
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: JEFF RUBIN
  • NPI Number: 1568520294
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 15D2096053
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name ALLISONVILLE
Street 5011 ALLISONVILLE ROAD
City INDIANAPOLIS
State IN
ZIP 46205
Phone 317 258-6041
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/27/2025
Certificate Expiration Date 8/26/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director JEFF RUBIN

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