22D2151658 CLIA NUMBER - DAVENPORT MEMORIAL HOME

Laboratory Demographics

CLIA Number: 22D2151658

Facility Name: DAVENPORT MEMORIAL HOME

Facility Address:
70 SALEM STREET
MALDEN, MA
ZIP 02148
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Facility Phone Number: 781 324-0150

Facility Type: Other - LONG TERM CARE LEVEL IV

Certificate Type: Waiver

NPI Number: 1891989000

Taxonomy: 311Z00000X - Custodial Care Facility
A facility providing care that serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, and using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered. Custodial care essentially is personal care that does not require the continuing attention of trained medical or paramedical personnel.

CLIA Record

Field Name	Field Value
CLIA Number	22D2151658
LAB Type	Other - LONG TERM CARE LEVEL IV
Facility Name	DAVENPORT MEMORIAL HOME
Street	70 SALEM STREET
City	MALDEN
State	MA
ZIP	02148
Phone	781 324-0150
CertificateType	4
CertificateEffectiveDate	7/24/2022
CertificateExpirationDate	7/23/2024
FacilityType	Waiver

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