13D2194053 CLIA NUMBER - GRACE AT STATE STREET LLC

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Laboratory Demographics

CLIA Number: 13D2194053

Facility Name: GRACE AT STATE STREET LLC

Facility Address:
9995 W STATE ST
BOISE, ID
ZIP 83714
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Facility Phone Number: 208 342-1312

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1356965693

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	13D2194053
LAB Type	Assisted Living Facility
Facility Name	GRACE AT STATE STREET LLC
Street	9995 W STATE ST
City	BOISE
State	ID
ZIP	83714
Phone	208 342-1312
CertificateType	4
CertificateEffectiveDate	9/28/2022
CertificateExpirationDate	9/27/2024
FacilityType	Waiver

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