10D2201041 CLIA NUMBER - CHRISTALLIS MANOR III DBA BEACHSIDE LIVING LLC

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Laboratory Demographics

CLIA Number: 10D2201041

Facility Name: CHRISTALLIS MANOR III DBA BEACHSIDE LIVING LLC

Facility Address:
420 N RIVERSIDE DR
POMPANO BEACH, FL
ZIP 33062
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Facility Phone Number: 954 788-8350

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1083228332

Taxonomy: 3104A0630X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors.

CLIA Record

Field Name	Field Value
CLIA Number	10D2201041
LAB Type	Assisted Living Facility
Facility Name	CHRISTALLIS MANOR III DBA BEACHSIDE LIVING LLC
Street	420 N RIVERSIDE DR
City	POMPANO BEACH
State	FL
ZIP	33062
Phone	954 788-8350
CertificateType	4
CertificateEffectiveDate	11/18/2022
CertificateExpirationDate	11/17/2024
FacilityType	Waiver

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