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GRACE MEMORY CARE AT STATE STREET LLC
NPI 1164046413
Assisted Living Facility in Boise, ID

Active since June 02, 2020CLIA 13D2194062 · Waiver
9779 W STATE ST, BOISE, ID 83714(208) 853-3337 Get Directions Write a Review

NPPES record last updated: June 2, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Grace Memory Care At State Street Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRACE MEMORY CARE AT STATE STREET LLC (NPI 1164046413) is a healthcare organization registered as an assisted living facility in Boise, Idaho and active in the NPI registry since June 2020. The organization holds a CLIA Waiver certificate valid through September 27, 2026 and lists Linda Hines, Owner, as its authorized official.

NPPES Registry Identity

NPI1164046413
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameGRACE MEMORY CARE AT STATE STREET LLC
Location Address9779 W STATE STBoise, ID 83714-1638
Mailing Address890 N Cole RdBoise, ID 83704-8638 · (208) 853-3337
Phone(208) 853-3337
Organization SubpartNo
Authorized OfficialLinda HinesOwner · (208) 853-3337
Enumeration DateJune 2, 2020
NPPES CertifiedJune 2, 2020
✔ NPI 1164046413 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
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.
9779 W STATE ST, Boise, ID 83714
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Other Identifiers 1

MedicaidA0003650ID

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2194062

Grace Memory Care At State Street LLC · Boise, ID
Active · expires Sep 27, 2026
CLIA Number13D2194062
Laboratory TypeAssisted Living Facility
Certificate Effective DateSeptember 28, 2024
Certificate Expiration DateSeptember 27, 2026
Laboratory DirectorMonica Heath
Laboratory Phone(208) 853-3337
Laboratory LocationGrace Memory Care At State Street LLC9779 W State St, Boise, ID 83714
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grace Memory Care At State Street LLC's NPI number?

The NPI number for Grace Memory Care At State Street LLC is 1164046413. It was assigned to this organization in the NPPES registry on June 2, 2020.

Where is Grace Memory Care At State Street LLC located?

Grace Memory Care At State Street LLC is located at 9779 W State St, Boise, ID 83714. The listed phone number is (208) 853-3337.

What is Grace Memory Care At State Street LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Grace Memory Care At State Street LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2194062) is associated with this NPI, valid through September 27, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Grace Memory Care At State Street LLC was last updated on June 2, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.