15D2154544 CLIA NUMBER - GRAND BROOK MEMORY CARE OF FISHERS

Laboratory Demographics

CLIA Number: 15D2154544

Facility Name: GRAND BROOK MEMORY CARE OF FISHERS

Facility Address:
9796 131ST STREET
FISHERS, IN
ZIP 46038
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Facility Phone Number: 469 331-8200

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1508461062

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	15D2154544
LAB Type	Assisted Living Facility
Facility Name	GRAND BROOK MEMORY CARE OF FISHERS
Street	9796 131ST STREET
City	FISHERS
State	IN
ZIP	46038
Phone	469 331-8200
CertificateType	4
CertificateEffectiveDate	9/14/2022
CertificateExpirationDate	9/13/2024
FacilityType	Waiver

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