23D2205567 CLIA NUMBER - BENJAMIN'S HOPE

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Laboratory Demographics

CLIA Number: 23D2205567

Facility Name: BENJAMIN'S HOPE

Facility Address:
15468 RILEY ST
HOLLAND, MI
ZIP 49424
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Facility Phone Number: 616 399-6293

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1255775318

Taxonomy: 311ZA0620X - Custodial Care Facility
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.

CLIA Record

Field Name	Field Value
CLIA Number	23D2205567
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	BENJAMIN'S HOPE
Street	15468 RILEY ST
City	HOLLAND
State	MI
ZIP	49424
Phone	616 399-6293
CertificateType	4
CertificateEffectiveDate	12/15/2022
CertificateExpirationDate	12/14/2024
FacilityType	Waiver

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