15D2149009 CLIA NUMBER - FIVE STAR RESIDENCES OF FORT WAYNE

Laboratory Demographics

  • CLIA Code: 15D2149009
  • Facility Name: FIVE STAR RESIDENCES OF FORT WAYNE
  • Facility Address: 2601 COVINGTON COMMONS DRIVE
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 432-1932
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: NIKKI ROGERS
  • NPI Number: 1841365434
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D2149009
LAB Type Assisted Living Facility
Facility Name FIVE STAR RESIDENCES OF FORT WAYNE
Street 2601 COVINGTON COMMONS DRIVE
City FORT WAYNE
State IN
ZIP 46804
Phone 260 432-1932
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2024
Certificate Expiration Date 5/22/2026
Facility Type Assisted Living Facility
Lab Director NIKKI ROGERS

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