08D2187648 CLIA NUMBER - STATE STREET ASSISTED LIVING

Laboratory Demographics

CLIA Number: 08D2187648

Facility Name: STATE STREET ASSISTED LIVING

Facility Address:
21 N STATE STREET
DOVER, DE
ZIP 19901
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Facility Phone Number: 302 674-2144

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1851763718

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	08D2187648
LAB Type	Assisted Living Facility
Facility Name	STATE STREET ASSISTED LIVING
Street	21 N STATE STREET
City	DOVER
State	DE
ZIP	19901
Phone	302 674-2144
CertificateType	4
CertificateEffectiveDate	7/6/2022
CertificateExpirationDate	7/5/2024
FacilityType	Waiver

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