13D2296974 CLIA NUMBER - COPPER FALLS HOSPICE LLC

Laboratory Demographics

CLIA Number: 13D2296974

Facility Name: COPPER FALLS HOSPICE LLC

Facility Address:
1830 S EAGLE RD
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 995-2453

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1881468189

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	13D2296974
LAB Type	Hospice
Facility Name	COPPER FALLS HOSPICE LLC
Street	1830 S EAGLE RD
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 995-2453
CertificateType	4
CertificateEffectiveDate	1/9/2024
CertificateExpirationDate	1/8/2026
FacilityType	Waiver

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