35D1100234 CLIA NUMBER - EDGEWOOD VISTA AT EDGEWOOD VILLAGE

Laboratory Demographics

CLIA Number: 35D1100234

Facility Name: EDGEWOOD VISTA AT EDGEWOOD VILLAGE

Facility Address:
3124 COLORADO LANE
BISMARCK, ND
ZIP 58503
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Facility Phone Number: 701 751-1446

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1932588621

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	35D1100234
LAB Type	Assisted Living Facility
Facility Name	EDGEWOOD VISTA AT EDGEWOOD VILLAGE
Street	3124 COLORADO LANE
City	BISMARCK
State	ND
ZIP	58503
Phone	701 751-1446
CertificateType	4
CertificateEffectiveDate	6/2/2023
CertificateExpirationDate	6/1/2025
FacilityType	Waiver

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