35D0952043 CLIA NUMBER - EDGEWOOD BISMARCK SENIOR LIVING, LLC DBA EDGEWOOD VISTA BISMARCK

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Laboratory Demographics

CLIA Number: 35D0952043

Facility Name: EDGEWOOD BISMARCK SENIOR LIVING, LLC DBA EDGEWOOD VISTA BISMARCK

Facility Address:
3406 DOMINION ST
BISMARCK, ND
ZIP 58503
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Facility Phone Number: 701 258-7489

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1598936247

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	35D0952043
LAB Type	Other
Facility Name	EDGEWOOD BISMARCK SENIOR LIVING, LLC DBA EDGEWOOD VISTA BISMARCK
Street	3406 DOMINION ST
City	BISMARCK
State	ND
ZIP	58503
Phone	701 258-7489
CertificateType	4
CertificateEffectiveDate	10/2/2022
CertificateExpirationDate	10/1/2024
FacilityType	Waiver

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