43D2248473 CLIA NUMBER - FAIRMONT GRAND SENIOR LIVING

Laboratory Demographics

CLIA Number: 43D2248473

Facility Name: FAIRMONT GRAND SENIOR LIVING

Facility Address:
409 EAST FAIRLANE DRIVE
RAPID CITY, SD
ZIP 57701
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Facility Phone Number: 605 399-1551

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1043422918

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	43D2248473
LAB Type	Assisted Living Facility
Facility Name	FAIRMONT GRAND SENIOR LIVING
Street	409 EAST FAIRLANE DRIVE
City	RAPID CITY
State	SD
ZIP	57701
Phone	605 399-1551
CertificateType	4
CertificateEffectiveDate	1/13/2024
CertificateExpirationDate	1/12/2026
FacilityType	Waiver

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