13D2259186 CLIA NUMBER - GRANGEVILLE OF CASCADIA LLC

Laboratory Demographics

  • CLIA Code: 13D2259186
  • Facility Name: GRANGEVILLE OF CASCADIA LLC
  • Facility Address: 410 NE 2ND ST
    GRANGEVILLE, ID
    ZIP 83530
  • Facility Phone: 208 983-1131
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MICHAEL BOWLDEN
  • NPI Number: 1528099744
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 13D2259186
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name GRANGEVILLE OF CASCADIA LLC
Street 410 NE 2ND ST
City GRANGEVILLE
State ID
ZIP 83530
Phone 208 983-1131
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2024
Certificate Expiration Date 5/2/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MICHAEL BOWLDEN

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