24D0703799 CLIA NUMBER - HAVEN HOMES MAPLE PLAIN

Laboratory Demographics

  • CLIA Code: 24D0703799
  • Facility Name: HAVEN HOMES MAPLE PLAIN
  • Facility Address: 4848 GATEWAY BLVD
    MAPLE PLAIN, MN
    ZIP 55359
  • Facility Phone: 612 479-1993
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: TAMARA L. JUNTILLA
  • NPI Number: 1447253661
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D0703799
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name HAVEN HOMES MAPLE PLAIN
Street 4848 GATEWAY BLVD
City MAPLE PLAIN
State MN
ZIP 55359
Phone 612 479-1993
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 TAMARA L. JUNTILLA

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