50D2254579 CLIA NUMBER - EVERGREEN FOUNTAINS LLC

Laboratory Demographics

  • CLIA Code: 50D2254579
  • Facility Name: EVERGREEN FOUNTAINS LLC
  • Facility Address: 1201 N EVERGREEN RD
    SPOKANE VALLEY, WA
    ZIP 99216
  • Facility Phone: 509 922-3100
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: PROKEY ARGER
  • NPI Number: 1255723391
  • Taxonomy: 335E00000X - Prosthetic/Orthotic Supplier

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CLIA Record

Field Name Field Value
CLIA Number 50D2254579
LAB Type Assisted Living Facility
Facility Name EVERGREEN FOUNTAINS LLC
Street 1201 N EVERGREEN RD
City SPOKANE VALLEY
State WA
ZIP 99216
Phone 509 922-3100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2022
Certificate Expiration Date 4/4/2028
Facility Type Assisted Living Facility
Lab Director PROKEY ARGER

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