46D2196288 CLIA NUMBER - CACHE VALLEY ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 46D2196288
  • Facility Name: CACHE VALLEY ASSISTED LIVING
  • Facility Address: 333 N MAIN ST
    PROVIDENCE, UT
    ZIP 84332
  • Facility Phone: 435 792-4770
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: ROSS R. THOMAS
  • NPI Number: 1144549122
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 46D2196288
LAB Type Assisted Living Facility
Facility Name CACHE VALLEY ASSISTED LIVING
Street 333 N MAIN ST
City PROVIDENCE
State UT
ZIP 84332
Phone 435 792-4770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2024
Certificate Expiration Date 10/14/2026
Facility Type Assisted Living Facility
Lab Director ROSS R. THOMAS

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