24D1002313 CLIA NUMBER - MINNESOTA CORRECTIONAL FACILITY WILLOW RIVER/MOOSE LAKE

Laboratory Demographics

  • CLIA Code: 24D1002313
  • Facility Name: MINNESOTA CORRECTIONAL FACILITY WILLOW RIVER/MOOSE LAKE
  • Facility Address: 1000 LAKESHORE DRIVE
    MOOSE LAKE, MN
    ZIP 55767
  • Facility Phone: 218 485-5055
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: SARAH KRUEGER
  • NPI Number: 1730354549
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D1002313
LAB Type Ambulance
Facility Name MINNESOTA CORRECTIONAL FACILITY WILLOW RIVER/MOOSE LAKE
Street 1000 LAKESHORE DRIVE
City MOOSE LAKE
State MN
ZIP 55767
Phone 218 485-5055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2024
Certificate Expiration Date 8/4/2026
Facility Type Ambulance
Lab Director SARAH KRUEGER

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