24D0700197 CLIA NUMBER - GRAND VILLAGE

Laboratory Demographics

  • CLIA Code: 24D0700197
  • Facility Name: GRAND VILLAGE
  • Facility Address: 923 HALE LAKE ROAD
    GRAND RAPIDS, MN
    ZIP 55744
  • Facility Phone: 218 326-0543
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: HOLLY MOORE
  • NPI Number: 1184662793
  • Taxonomy: 314000000X - Skilled Nursing Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 24D0700197
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name GRAND VILLAGE
Street 923 HALE LAKE ROAD
City GRAND RAPIDS
State MN
ZIP 55744
Phone 218 326-0543
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 HOLLY MOORE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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