15D2178976 CLIA NUMBER - SILVER BIRCH AT COOK ROAD

Laboratory Demographics

CLIA Number: 15D2178976

Facility Name: SILVER BIRCH AT COOK ROAD

Facility Address:
3731 WEST COOK ROAD
FORT WAYNE, IN
ZIP 46818
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Facility Phone Number: 260 490-2112

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1730712886

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	15D2178976
LAB Type	Assisted Living Facility
Facility Name	SILVER BIRCH AT COOK ROAD
Street	3731 WEST COOK ROAD
City	FORT WAYNE
State	IN
ZIP	46818
Phone	260 490-2112
CertificateType	4
CertificateEffectiveDate	2/12/2024
CertificateExpirationDate	2/11/2026
FacilityType	Waiver

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