15D2319528 CLIA NUMBER - ALLENDALE BEHAVIORAL HEALTH LLC

Laboratory Demographics

  • CLIA Code: 15D2319528
  • Facility Name: ALLENDALE BEHAVIORAL HEALTH LLC
  • Facility Address: 454 E DUPONT RD
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 260 370-8227
  • Facility Type: Other - MENTAL HEALTH/SUD TREATME
  • Facility Type: Waiver
  • Lab Director: NICOLE L. HAMER
  • NPI Number: 1356007934
  • Taxonomy: 261QM0855X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2319528
LAB Type Other - MENTAL HEALTH/SUD TREATME
Facility Name ALLENDALE BEHAVIORAL HEALTH LLC
Street 454 E DUPONT RD
City FORT WAYNE
State IN
ZIP 46825
Phone 260 370-8227
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2025
Certificate Expiration Date 3/2/2027
Facility Type Other - MENTAL HEALTH/SUD TREATME
Lab Director NICOLE L. HAMER

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