15D2144592 CLIA NUMBER - FORT WAYNE RECOVERY LLC

Laboratory Demographics

  • CLIA Code: 15D2144592
  • Facility Name: FORT WAYNE RECOVERY LLC
  • Facility Address: 310 E DUPONT RD
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 833 762-3739
  • Facility Type: Other - SUBSTANCE USE TREATMENT
  • Facility Type: Waiver
  • Lab Director: NICOLE L. HAMER
  • NPI Number: 1437658572
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2144592
LAB Type Other - SUBSTANCE USE TREATMENT
Facility Name FORT WAYNE RECOVERY LLC
Street 310 E DUPONT RD
City FORT WAYNE
State IN
ZIP 46825
Phone 833 762-3739
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/20/2024
Certificate Expiration Date 2/19/2026
Facility Type Other - SUBSTANCE USE TREATMENT
Lab Director NICOLE L. HAMER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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