20D2245747 CLIA NUMBER - FALLBROOK WOODS RESIDENTIAL CARE FACILITY

Laboratory Demographics

CLIA Number: 20D2245747

Facility Name: FALLBROOK WOODS RESIDENTIAL CARE FACILITY

Facility Address:
60 MERRYMEETING DR
PORTLAND, ME
ZIP 04103
Get Directions

Facility Phone Number: 207 878-0788

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1477881951

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	20D2245747
LAB Type	Assisted Living Facility
Facility Name	FALLBROOK WOODS RESIDENTIAL CARE FACILITY
Street	60 MERRYMEETING DR
City	PORTLAND
State	ME
ZIP	04103
Phone	207 878-0788
CertificateType	4
CertificateEffectiveDate	12/16/2023
CertificateExpirationDate	12/15/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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