15D2150255 CLIA NUMBER - VISTACARE USA, LLC- INDIANAPOLIS SOUTH

Laboratory Demographics

CLIA Number: 15D2150255

Facility Name: VISTACARE USA, LLC- INDIANAPOLIS SOUTH

Facility Address:
37 SOUTH PARK BOULEVARD
GREENWOOD, IN
ZIP 46143
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Facility Phone Number: 704 664-2876

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1629086707

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	15D2150255
LAB Type	Hospice
Facility Name	VISTACARE USA, LLC- INDIANAPOLIS SOUTH
Street	37 SOUTH PARK BOULEVARD
City	GREENWOOD
State	IN
ZIP	46143
Phone	704 664-2876
CertificateType	4
CertificateEffectiveDate	6/20/2022
CertificateExpirationDate	6/19/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024