02D1014850 CLIA NUMBER - NORTH STAR RESIDENTIAL TREATMENT CENTER PALMER RESIDENTIAL TREATMENT CENTER

Laboratory Demographics

CLIA Number: 02D1014850

Facility Name: NORTH STAR RESIDENTIAL TREATMENT CENTER PALMER RESIDENTIAL TREATMENT CENTER

Facility Address:
MILE 2 1/2 CLARK-WOLVERINE ROAD
PALMER, AK
ZIP 99645
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Facility Phone Number: 907 746-7541

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1124142328

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	02D1014850
LAB Type	Other
Facility Name	NORTH STAR RESIDENTIAL TREATMENT CENTER PALMER RESIDENTIAL TREATMENT CENTER
Street	MILE 2 1/2 CLARK-WOLVERINE ROAD
City	PALMER
State	AK
ZIP	99645
Phone	907 746-7541
CertificateType	4
CertificateEffectiveDate	7/17/2023
CertificateExpirationDate	7/16/2025
FacilityType	Waiver

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