15D2150679 CLIA NUMBER - ACTIVE DAY OF FORT WAYNE

Laboratory Demographics

  • CLIA Code: 15D2150679
  • Facility Name: ACTIVE DAY OF FORT WAYNE
  • Facility Address: 3711 RUPP DRIVE SUITE 106
    FORT WAYNE, IN
    ZIP 46815
  • Facility Phone: 260 484-2414
  • Facility Type: Other - MEDICAL ADULT DAY CARE
  • Facility Type: Waiver
  • Lab Director: VALERIE O BRIEN
  • NPI Number: 1730628322
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2150679
LAB Type Other - MEDICAL ADULT DAY CARE
Facility Name ACTIVE DAY OF FORT WAYNE
Street 3711 RUPP DRIVE SUITE 106
City FORT WAYNE
State IN
ZIP 46815
Phone 260 484-2414
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2024
Certificate Expiration Date 6/28/2026
Facility Type Other - MEDICAL ADULT DAY CARE
Lab Director VALERIE O BRIEN

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