23D0708812 CLIA NUMBER - BOULDER PARK TERRACE

Laboratory Demographics

  • CLIA Code: 23D0708812
  • Facility Name: BOULDER PARK TERRACE
  • Facility Address: 14676 WEST UPRIGHT STREET
    CHARLEVOIX, MI
    ZIP 49720
  • Facility Phone: 231 237-8009
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: TRAVIS S. JOHNECHECK
  • NPI Number: 1508962069
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 23D0708812
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BOULDER PARK TERRACE
Street 14676 WEST UPRIGHT STREET
City CHARLEVOIX
State MI
ZIP 49720
Phone 231 237-8009
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director TRAVIS S. JOHNECHECK

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This page was last updated on: 9/29/2025