13D2192420 CLIA NUMBER - TABLE ROCK SENIOR LIVING AT PARAMOUNT

Laboratory Demographics

  • CLIA Code: 13D2192420
  • Facility Name: TABLE ROCK SENIOR LIVING AT PARAMOUNT
  • Facility Address: 6280 N FOX RUN WAY
    MERIDIAN, ID
    ZIP 83646
  • Facility Phone: 208 639-0009
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: HEATH BRAVERMAN
  • NPI Number: 1508329343
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 13D2192420
LAB Type Assisted Living Facility
Facility Name TABLE ROCK SENIOR LIVING AT PARAMOUNT
Street 6280 N FOX RUN WAY
City MERIDIAN
State ID
ZIP 83646
Phone 208 639-0009
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2024
Certificate Expiration Date 9/9/2026
Facility Type Assisted Living Facility
Lab Director HEATH BRAVERMAN

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