16D2140809 CLIA NUMBER - EDENCREST AT BEAVERDALE

Laboratory Demographics

CLIA Number: 16D2140809

Facility Name: EDENCREST AT BEAVERDALE

Facility Address:
3410 BEAVER AVENUE
DES MOINES, IA
ZIP 50310
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Facility Phone Number: 515 777-5105

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1427563022

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	16D2140809
LAB Type	Assisted Living Facility
Facility Name	EDENCREST AT BEAVERDALE
Street	3410 BEAVER AVENUE
City	DES MOINES
State	IA
ZIP	50310
Phone	515 777-5105
CertificateType	4
CertificateEffectiveDate	11/30/2023
CertificateExpirationDate	11/29/2025
FacilityType	Waiver

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