13D2194062 CLIA NUMBER - GRACE MEMORY CARE AT STATE STREET LLC

Laboratory Demographics

  • CLIA Code: 13D2194062
  • Facility Name: GRACE MEMORY CARE AT STATE STREET LLC
  • Facility Address: 9779 W STATE ST
    BOISE, ID
    ZIP 83714
  • Facility Phone: 208 853-3337
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MONICA HEATH
  • NPI Number: 1164046413
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 13D2194062
LAB Type Assisted Living Facility
Facility Name GRACE MEMORY CARE AT STATE STREET LLC
Street 9779 W STATE ST
City BOISE
State ID
ZIP 83714
Phone 208 853-3337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2024
Certificate Expiration Date 9/27/2026
Facility Type Assisted Living Facility
Lab Director MONICA HEATH

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