24D0996196 CLIA NUMBER - ECUMEN LAKEVIEW COMMONS

Laboratory Demographics

CLIA Number: 24D0996196

Facility Name: ECUMEN LAKEVIEW COMMONS

Facility Address:
1200 NORTH LAKEWOOD DRIVE
MAPLEWOOD, MN
ZIP 55119
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Facility Phone Number: 651 770-1111

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1649484601

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	24D0996196
LAB Type	Assisted Living Facility
Facility Name	ECUMEN LAKEVIEW COMMONS
Street	1200 NORTH LAKEWOOD DRIVE
City	MAPLEWOOD
State	MN
ZIP	55119
Phone	651 770-1111
CertificateType	4
CertificateEffectiveDate	2/12/2024
CertificateExpirationDate	2/11/2026
FacilityType	Waiver

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