13D2195037 CLIA NUMBER - EDGEWOOD SPRING CREEK EAGLE LLC

Laboratory Demographics

  • CLIA Code: 13D2195037
  • Facility Name: EDGEWOOD SPRING CREEK EAGLE LLC
  • Facility Address: 653 N EAGLE RD
    EAGLE, ID
    ZIP 83616
  • Facility Phone: 208 938-5578
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: TORY HANSEN
  • NPI Number: 1003191149
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 13D2195037
LAB Type Assisted Living Facility
Facility Name EDGEWOOD SPRING CREEK EAGLE LLC
Street 653 N EAGLE RD
City EAGLE
State ID
ZIP 83616
Phone 208 938-5578
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 TORY HANSEN

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