13D2201173 CLIA NUMBER - BROOKDALE COEUR D'ALENE

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Laboratory Demographics

CLIA Number: 13D2201173

Facility Name: BROOKDALE COEUR D'ALENE

Facility Address:
205 E ANTON AVENUE
COEUR D'ALENE, ID
ZIP 83815
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Facility Phone Number: 028 667-6490

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1609088525

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	13D2201173
LAB Type	Assisted Living Facility
Facility Name	BROOKDALE COEUR D'ALENE
Street	205 E ANTON AVENUE
City	COEUR D'ALENE
State	ID
ZIP	83815
Phone	028 667-6490
CertificateType	4
CertificateEffectiveDate	11/19/2022
CertificateExpirationDate	11/18/2024
FacilityType	Waiver

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