10D2233765 CLIA NUMBER - KINGS CROWN- SHELL POINT VILLAGE

Laboratory Demographics

CLIA Number: 10D2233765

Facility Name: KINGS CROWN- SHELL POINT VILLAGE

Facility Address:
3699 KINGS CROWN CT
FORT MYERS, FL
ZIP 33908
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Facility Phone Number: 239 454-2179

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1386073088

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	10D2233765
LAB Type	Assisted Living Facility
Facility Name	KINGS CROWN- SHELL POINT VILLAGE
Street	3699 KINGS CROWN CT
City	FORT MYERS
State	FL
ZIP	33908
Phone	239 454-2179
CertificateType	4
CertificateEffectiveDate	8/25/2023
CertificateExpirationDate	8/24/2025
FacilityType	Waiver

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