15D2176654 CLIA NUMBER - FAYETTE BEHAVIORAL HEALTH COMPLEX

Laboratory Demographics

  • CLIA Code: 15D2176654
  • Facility Name: FAYETTE BEHAVIORAL HEALTH COMPLEX
  • Facility Address: 450 ERIE AVE
    CONNERSVILLE, IN
    ZIP 47331
  • Facility Phone: 765 827-7890
  • Facility Type: Other - INPATIENT RESIDENTIAL & O
  • Facility Type: Waiver
  • Lab Director: VAHID OSMAN
  • NPI Number: 1194207316
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 15D2176654
LAB Type Other - INPATIENT RESIDENTIAL & O
Facility Name FAYETTE BEHAVIORAL HEALTH COMPLEX
Street 450 ERIE AVE
City CONNERSVILLE
State IN
ZIP 47331
Phone 765 827-7890
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2023
Certificate Expiration Date 12/18/2025
Facility Type Other - INPATIENT RESIDENTIAL & O
Lab Director VAHID OSMAN

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