50D2141989 CLIA NUMBER - PROVIDENCE ADULT DAY HEALTH

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Laboratory Demographics

CLIA Number: 50D2141989

Facility Name: PROVIDENCE ADULT DAY HEALTH

Facility Address:
6018 N ASTOR ST
SPOKANE, WA
ZIP 99208
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Facility Phone Number: 509 482-2475

Facility Type: Other - ADULT DAY HEALTH

Certificate Type: Waiver

NPI Number: 1194887588

Taxonomy: 385H00000X - Respite Care

CLIA Record

Field Name	Field Value
CLIA Number	50D2141989
LAB Type	Other - ADULT DAY HEALTH
Facility Name	PROVIDENCE ADULT DAY HEALTH
Street	6018 N ASTOR ST
City	SPOKANE
State	WA
ZIP	99208
Phone	509 482-2475
CertificateType	4
CertificateEffectiveDate	12/28/2017
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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