13D2293359 CLIA NUMBER - ALERACARE-BOISE

Laboratory Demographics

CLIA Number: 13D2293359

Facility Name: ALERACARE-BOISE

Facility Address:
1449 S DAVID LN STE 120
BOISE, ID
ZIP 83705
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Facility Phone Number: 888 209-8874

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1982378808

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2293359
LAB Type	Physician Office
Facility Name	ALERACARE-BOISE
Street	1449 S DAVID LN STE 120
City	BOISE
State	ID
ZIP	83705
Phone	888 209-8874
CertificateType	4
CertificateEffectiveDate	11/7/2023
CertificateExpirationDate	11/6/2025
FacilityType	Waiver

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