13D2111869 CLIA NUMBER - KEYSTONE HEALTH AND HOSPICE CARE

Laboratory Demographics

  • CLIA Code: 13D2111869
  • Facility Name: KEYSTONE HEALTH AND HOSPICE CARE
  • Facility Address: 21 N FISHER PARK WAY
    EAGLE, ID
    ZIP 83616
  • Facility Phone: 208 514-0670
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LEONARD R. JENSEN
  • NPI Number: 1932520640
  • Taxonomy: 363LG0600X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 13D2111869
LAB Type Physician Office
Facility Name KEYSTONE HEALTH AND HOSPICE CARE
Street 21 N FISHER PARK WAY
City EAGLE
State ID
ZIP 83616
Phone 208 514-0670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2024
Certificate Expiration Date 4/17/2026
Facility Type Physician Office
Lab Director LEONARD R. JENSEN

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This page was last updated on: 9/29/2025