15D2171520 CLIA NUMBER - BRIGHTSTAR SENIOR LIVING OPERATIONS OF FORT WAYNE

Laboratory Demographics

CLIA Number: 15D2171520

Facility Name: BRIGHTSTAR SENIOR LIVING OPERATIONS OF FORT WAYNE

Facility Address:
11430 COLDWATER RD
FORT WAYNE, IN
ZIP 46845
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Facility Phone Number: 260 234-2929

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1639832405

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	15D2171520
LAB Type	Assisted Living Facility
Facility Name	BRIGHTSTAR SENIOR LIVING OPERATIONS OF FORT WAYNE
Street	11430 COLDWATER RD
City	FORT WAYNE
State	IN
ZIP	46845
Phone	260 234-2929
CertificateType	4
CertificateEffectiveDate	9/3/2023
CertificateExpirationDate	9/2/2025
FacilityType	Waiver

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