23D0918417 CLIA NUMBER - BOULEVARD TEMPLE RETIREMENT COMMUNITY

Laboratory Demographics

  • CLIA Code: 23D0918417
  • Facility Name: BOULEVARD TEMPLE RETIREMENT COMMUNITY
  • Facility Address: 2567 W GRAND BLVD
    DETROIT, MI
    ZIP 48208
  • Facility Phone: 313 895-5340
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: LISA A. DIMITRIE
  • NPI Number: 1689805970
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 23D0918417
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BOULEVARD TEMPLE RETIREMENT COMMUNITY
Street 2567 W GRAND BLVD
City DETROIT
State MI
ZIP 48208
Phone 313 895-5340
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/8/2024
Certificate Expiration Date 8/7/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director LISA A. DIMITRIE

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