15D2125639 CLIA NUMBER - EVERSIDE HEALTH, LLC CITY OF MISHAWAKA

Laboratory Demographics

  • CLIA Code: 15D2125639
  • Facility Name: EVERSIDE HEALTH, LLC CITY OF MISHAWAKA
  • Facility Address: 333 EAST MISHAWAKA AVENUE
    MISHAWAKA, IN
    ZIP 46545
  • Facility Phone: 704 936-5546
  • Facility Type: Other - CHRONIC MGT
  • Facility Type: Waiver
  • Lab Director: SARAH KOLACZ
  • NPI Number: 1619513603
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2125639
LAB Type Other - CHRONIC MGT
Facility Name EVERSIDE HEALTH, LLC CITY OF MISHAWAKA
Street 333 EAST MISHAWAKA AVENUE
City MISHAWAKA
State IN
ZIP 46545
Phone 704 936-5546
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2025
Certificate Expiration Date 2/9/2027
Facility Type Other - CHRONIC MGT
Lab Director SARAH KOLACZ

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