15D2261119 CLIA NUMBER - GLASSWATER CREEK OF WHITESTOWN

Laboratory Demographics

CLIA Number: 15D2261119

Facility Name: GLASSWATER CREEK OF WHITESTOWN

Facility Address:
5829 NEW HOPE BLVD
WHITESTOWN, IN
ZIP 46075
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Facility Phone Number: 436 209-8670

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1235895293

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	15D2261119
LAB Type	Assisted Living Facility
Facility Name	GLASSWATER CREEK OF WHITESTOWN
Street	5829 NEW HOPE BLVD
City	WHITESTOWN
State	IN
ZIP	46075
Phone	436 209-8670
CertificateType	4
CertificateEffectiveDate	5/26/2022
CertificateExpirationDate	5/25/2024
FacilityType	Waiver

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