13D2268983 CLIA NUMBER - HILLCREST MANOR LLC

Laboratory Demographics

  • CLIA Code: 13D2268983
  • Facility Name: HILLCREST MANOR LLC
  • Facility Address: 3901 W HILLCREST DR
    BOISE, ID
    ZIP 83705
  • Facility Phone: 208 424-0618
  • Facility Type: Other - MENTAL HEALTH
  • Facility Type: Waiver
  • Lab Director: LAURA L. HARTWIG
  • NPI Number: 1326386202
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D2268983
LAB Type Other - MENTAL HEALTH
Facility Name HILLCREST MANOR LLC
Street 3901 W HILLCREST DR
City BOISE
State ID
ZIP 83705
Phone 208 424-0618
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2024
Certificate Expiration Date 9/19/2026
Facility Type Other - MENTAL HEALTH
Lab Director LAURA L. HARTWIG

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This page was last updated on: 6/4/2025