15D2162946 CLIA NUMBER - SILVER BIRCH OF FORT WAYNE

Laboratory Demographics

CLIA Number: 15D2162946

Facility Name: SILVER BIRCH OF FORT WAYNE

Facility Address:
7125 S HANNA ST
FORT WAYNE, IN
ZIP 46816
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Facility Phone Number: 260 447-8811

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1073006938

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	15D2162946
LAB Type	Assisted Living Facility
Facility Name	SILVER BIRCH OF FORT WAYNE
Street	7125 S HANNA ST
City	FORT WAYNE
State	IN
ZIP	46816
Phone	260 447-8811
CertificateType	4
CertificateEffectiveDate	3/5/2023
CertificateExpirationDate	3/4/2025
FacilityType	Waiver

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