CLIA lab
CLIA 15D2171520: Pine Valley Assisted Living
Ft Wayne, IN. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 15D2171520 belongs to Pine Valley Assisted Living in Ft Wayne, IN.
Certificate of Waiver, effective September 3, 2025, expires September 2, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- September 3, 2025
- Certificate expiration
- September 2, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- September 3, 2019
- Facility type
- Assisted living facility
- Ownership (control type)
- Other
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 15D2171520
- Lab name
- Pine Valley Assisted Living
- Address
- 11430 Coldwater Rd, Ft Wayne, IN 46845
- Phone
- (260) 469-3909
- Fax
- (260) 918-8015
Annual test volume the lab reported
- Waived tests
- 500
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- Fort Wayne on the Go Mobile Drug & AlcoholCertificate of Waiver, Mobile lab15D2319515
- Fresenius Medical Care Fort Wayne JeffersonCertificate of Waiver, End stage renal disease dialysis facility15D0647525
- Great Lakes Caring Hospice Nin, LLC DBA ElaraCertificate of Waiver, Hospice15D2330740
- Holy Family Birth CenterCertificate of Waiver, Other15D2168308
- Iuhmg Riley SpecialistsCertificate of Waiver, Physician office15D2141694
- Karim Moshref MD PCCertificate for Provider-Performed Microscopy Procedures, Physician office15D0975862
- Kroger Pharmacy #425Certificate of Waiver, Pharmacy15D2093590
Related
Questions
What is the CLIA number for Pine Valley Assisted Living in Ft Wayne?
15D2171520, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Pine Valley Assisted Living hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 15D2171520 expire?
The CMS file lists September 2, 2027 as the certificate expiration date; the certificate took effect September 3, 2025.