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24D0900141 CLIA NUMBER - ST THERESE HOME, INC ST THERESE RESIDENCE NURSING

Laboratory Demographics

CLIA Number: 24D0900141

Facility Name: ST THERESE HOME, INC ST THERESE RESIDENCE NURSING

Facility Address:
8008 BASS LAKE ROAD
NEW HOPE, MN
ZIP 55428
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Facility Phone Number: 612 531-5400

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1790817187

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name Field Value
CLIA Number 24D0900141
LAB Type Home Health Agency
Facility Name ST THERESE HOME, INC ST THERESE RESIDENCE NURSING
Street 8008 BASS LAKE ROAD
City NEW HOPE
State MN
ZIP 55428
Phone 612 531-5400
CertificateType 4
CertificateEffectiveDate 4/18/2023
CertificateExpirationDate 4/17/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024