16D2107867 CLIA NUMBER - EDENCREST AT GREEN MEADOWS

Laboratory Demographics

CLIA Number: 16D2107867

Facility Name: EDENCREST AT GREEN MEADOWS

Facility Address:
6750 CORPORATE DRIVE
JOHNSTON, IA
ZIP 50131
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Facility Phone Number: 515 207-1984

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1194190595

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	16D2107867
LAB Type	Assisted Living Facility
Facility Name	EDENCREST AT GREEN MEADOWS
Street	6750 CORPORATE DRIVE
City	JOHNSTON
State	IA
ZIP	50131
Phone	515 207-1984
CertificateType	4
CertificateEffectiveDate	1/25/2024
CertificateExpirationDate	1/24/2026
FacilityType	Waiver

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