13D2195026 CLIA NUMBER - EDGEWOOD SPRING CREEK USTICK LLC

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Laboratory Demographics

CLIA Number: 13D2195026

Facility Name: EDGEWOOD SPRING CREEK USTICK LLC

Facility Address:
3165 N MERIDIAN RD
MERIDIAN, ID
ZIP 83646
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Facility Phone Number: 208 287-2064

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1225313737

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	13D2195026
LAB Type	Assisted Living Facility
Facility Name	EDGEWOOD SPRING CREEK USTICK LLC
Street	3165 N MERIDIAN RD
City	MERIDIAN
State	ID
ZIP	83646
Phone	208 287-2064
CertificateType	4
CertificateEffectiveDate	10/6/2022
CertificateExpirationDate	10/5/2024
FacilityType	Waiver

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