24D0402025 CLIA NUMBER - PARK HEALTH A VILLA CENTER

Laboratory Demographics

  • CLIA Code: 24D0402025
  • Facility Name: PARK HEALTH A VILLA CENTER
  • Facility Address: 4415 W 36TH 1/2 ST
    SAINT LOUIS PARK, MN
    ZIP 55416
  • Facility Phone: 952 927-9717
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: PAXTON WIFFLER
  • NPI Number: 1184798712
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D0402025
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PARK HEALTH A VILLA CENTER
Street 4415 W 36TH 1/2 ST
City SAINT LOUIS PARK
State MN
ZIP 55416
Phone 952 927-9717
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director PAXTON WIFFLER

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