13D2195029 CLIA NUMBER - EDGEWOOD SPRING CREEK OVERLAND LLC

Laboratory Demographics

  • CLIA Code: 13D2195029
  • Facility Name: EDGEWOOD SPRING CREEK OVERLAND LLC
  • Facility Address: 10139 W OVERLAND RD
    BOISE, ID
    ZIP 83709
  • Facility Phone: 208 639-7000
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: RAYVIN LOUGH
  • NPI Number: 1497038301
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 13D2195029
LAB Type Assisted Living Facility
Facility Name EDGEWOOD SPRING CREEK OVERLAND LLC
Street 10139 W OVERLAND RD
City BOISE
State ID
ZIP 83709
Phone 208 639-7000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/6/2024
Certificate Expiration Date 10/5/2026
Facility Type Assisted Living Facility
Lab Director RAYVIN LOUGH

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