36D0860777 CLIA NUMBER - I AM BOUNDLESS, INC

Laboratory Demographics

CLIA Number: 36D0860777

Facility Name: I AM BOUNDLESS, INC

Facility Address:
445 EAST DUBLIN GRANVILLE ROAD BUILDING G
WORTHINGTON, OH
ZIP 43085
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Facility Phone Number: 614 844-3600

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1013555408

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	36D0860777
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	I AM BOUNDLESS, INC
Street	445 EAST DUBLIN GRANVILLE ROAD BUILDING G
City	WORTHINGTON
State	OH
ZIP	43085
Phone	614 844-3600
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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