06D2228760 CLIA NUMBER - LEGACY AT MONTE VISTA

Laboratory Demographics

CLIA Number: 06D2228760

Facility Name: LEGACY AT MONTE VISTA

Facility Address:
100 CHICO CAMINO STREET
MONTE VISTA, CO
ZIP 81144
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Facility Phone Number: 719 852-5179

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1407817497

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	06D2228760
LAB Type	Assisted Living Facility
Facility Name	LEGACY AT MONTE VISTA
Street	100 CHICO CAMINO STREET
City	MONTE VISTA
State	CO
ZIP	81144
Phone	719 852-5179
CertificateType	4
CertificateEffectiveDate	6/30/2023
CertificateExpirationDate	6/29/2025
FacilityType	Waiver

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