15D2180935 CLIA NUMBER - APPLEGATE HEALTH SERVICES, INC APPLEGATE RECOVERY FORT WAYNE

Laboratory Demographics

  • CLIA Code: 15D2180935
  • Facility Name: APPLEGATE HEALTH SERVICES, INC APPLEGATE RECOVERY FORT WAYNE
  • Facility Address: 6017 STONEY CREEK DR
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 260 267-5159
  • Facility Type: Other - NARCOTIC TREATMENT PROGRA
  • Facility Type: Waiver
  • Lab Director: RICHARD MAENZA
  • NPI Number: 1982370011
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2180935
LAB Type Other - NARCOTIC TREATMENT PROGRA
Facility Name APPLEGATE HEALTH SERVICES, INC APPLEGATE RECOVERY FORT WAYNE
Street 6017 STONEY CREEK DR
City FORT WAYNE
State IN
ZIP 46825
Phone 260 267-5159
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2024
Certificate Expiration Date 3/23/2026
Facility Type Other - NARCOTIC TREATMENT PROGRA
Lab Director RICHARD MAENZA

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