36D0726684 CLIA NUMBER - OTTERBEIN TIPP CITY, LLC

Laboratory Demographics

  • CLIA Code: 36D0726684
  • Facility Name: OTTERBEIN TIPP CITY, LLC
  • Facility Address: 4375 SOUTH COUNTY ROAD 25A
    TIPP CITY, OH
    ZIP 45371
  • Facility Phone: 937 667-7500
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: KRISTIN L. JACKSON
  • NPI Number: 1891760963
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 36D0726684
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name OTTERBEIN TIPP CITY, LLC
Street 4375 SOUTH COUNTY ROAD 25A
City TIPP CITY
State OH
ZIP 45371
Phone 937 667-7500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director KRISTIN L. JACKSON

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