13D2195031 CLIA NUMBER - EDGEWOOD SPRING CREEK MERIDIAN LLC

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Laboratory Demographics

CLIA Number: 13D2195031

Facility Name: EDGEWOOD SPRING CREEK MERIDIAN LLC

Facility Address:
175 E CALDERWOOD DR
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 884-6199

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1891078705

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	13D2195031
LAB Type	Assisted Living Facility
Facility Name	EDGEWOOD SPRING CREEK MERIDIAN LLC
Street	175 E CALDERWOOD DR
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 884-6199
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