13D2269803 CLIA NUMBER - GOLDEN ANGEL RESIDENTIAL ASSISTED LIVING LLC

Laboratory Demographics

CLIA Number: 13D2269803

Facility Name: GOLDEN ANGEL RESIDENTIAL ASSISTED LIVING LLC

Facility Address:
2321 N KENMERE PL
MERIDIAN, ID
ZIP 83646
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Facility Phone Number: 208 207-2829

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1730823816

Taxonomy: 3104A0625X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies.

CLIA Record

Field Name	Field Value
CLIA Number	13D2269803
LAB Type	Assisted Living Facility
Facility Name	GOLDEN ANGEL RESIDENTIAL ASSISTED LIVING LLC
Street	2321 N KENMERE PL
City	MERIDIAN
State	ID
ZIP	83646
Phone	208 207-2829
CertificateType	4
CertificateEffectiveDate	10/4/2022
CertificateExpirationDate	10/3/2024
FacilityType	Waiver

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