24D1016198 CLIA NUMBER - THE LODGE OF MOUNTAIN LAKE

Laboratory Demographics

  • CLIA Code: 24D1016198
  • Facility Name: THE LODGE OF MOUNTAIN LAKE
  • Facility Address: 603 7TH AVENUE
    MOUNTAIN LAKE, MN
    ZIP 56159
  • Facility Phone: 507 427-2465
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JADA VOSHAGE HAMPEL
  • NPI Number: 1750622908
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D1016198
LAB Type Assisted Living Facility
Facility Name THE LODGE OF MOUNTAIN LAKE
Street 603 7TH AVENUE
City MOUNTAIN LAKE
State MN
ZIP 56159
Phone 507 427-2465
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2025
Certificate Expiration Date 8/21/2027
Facility Type Assisted Living Facility
Lab Director JADA VOSHAGE HAMPEL

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