24D0715530 CLIA NUMBER - HOMEWARD BOUND INC PLYMOUTH

Laboratory Demographics

CLIA Code: 24D0715530
Facility Name: HOMEWARD BOUND INC PLYMOUTH
Facility Address: 13522 SUNSET TRAIL
PLYMOUTH, MN
ZIP 55441
Facility Phone: 612 593-0527
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: NANCY H. BRADY
NPI Number: 1962589705
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	24D0715530
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	HOMEWARD BOUND INC PLYMOUTH
Street	13522 SUNSET TRAIL
City	PLYMOUTH
State	MN
ZIP	55441
Phone	612 593-0527
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	Intermediate Care Facility for Mentally Retarded
Lab Director	NANCY H. BRADY

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