50D2282128 CLIA NUMBER - BONNEY LAKE ADULT FAMILY HOME LLC

Laboratory Demographics

CLIA Number: 50D2282128

Facility Name: BONNEY LAKE ADULT FAMILY HOME LLC

Facility Address:
8407 184TH AVE E
BONNEY LAKE, WA
ZIP 98391
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Facility Phone Number: 253 447-8721

Facility Type: Other - AFH

Certificate Type: Waiver

NPI Number: 1477783199

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	50D2282128
LAB Type	Other - AFH
Facility Name	BONNEY LAKE ADULT FAMILY HOME LLC
Street	8407 184TH AVE E
City	BONNEY LAKE
State	WA
ZIP	98391
Phone	253 447-8721
CertificateType	4
CertificateEffectiveDate	5/17/2023
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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