24D0405854 CLIA NUMBER - BETHANY ON THE LAKE

Laboratory Demographics

  • CLIA Code: 24D0405854
  • Facility Name: BETHANY ON THE LAKE
  • Facility Address: 1020 LARK ST
    ALEXANDRIA, MN
    ZIP 56308
  • Facility Phone: 320 762-1567
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JESSICA DEZEEUW
  • NPI Number: 1609380500
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D0405854
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BETHANY ON THE LAKE
Street 1020 LARK ST
City ALEXANDRIA
State MN
ZIP 56308
Phone 320 762-1567
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 JESSICA DEZEEUW

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