13D2204157 CLIA NUMBER - BROOKDALE POCATELLO

Laboratory Demographics

  • CLIA Code: 13D2204157
  • Facility Name: BROOKDALE POCATELLO
  • Facility Address: 1501 BALDY AVENUE
    POCATELLO, ID
    ZIP 83201
  • Facility Phone: 208 237-6866
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: NICHOLE M. BORDEN
  • NPI Number: 1538294871
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 13D2204157
LAB Type Assisted Living Facility
Facility Name BROOKDALE POCATELLO
Street 1501 BALDY AVENUE
City POCATELLO
State ID
ZIP 83201
Phone 208 237-6866
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2024
Certificate Expiration Date 12/7/2026
Facility Type Assisted Living Facility
Lab Director NICHOLE M. BORDEN

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