24D1028387 CLIA NUMBER - AMIRA CHOICE CHAMPLIN LLC

Laboratory Demographics

CLIA Number: 24D1028387

Facility Name: AMIRA CHOICE CHAMPLIN LLC

Facility Address:
119 E HAYDEN LAKE RD
CHAMPLIN, MN
ZIP 55316
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Facility Phone Number: 763 712-0118

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1194845107

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	24D1028387
LAB Type	Assisted Living Facility
Facility Name	AMIRA CHOICE CHAMPLIN LLC
Street	119 E HAYDEN LAKE RD
City	CHAMPLIN
State	MN
ZIP	55316
Phone	763 712-0118
CertificateType	4
CertificateEffectiveDate	7/23/2022
CertificateExpirationDate	7/22/2024
FacilityType	Waiver

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