24D1029904 CLIA NUMBER - AUGUSTANA EMERALD CARE OF SHAKOPEE

Laboratory Demographics

CLIA Number: 24D1029904

Facility Name: AUGUSTANA EMERALD CARE OF SHAKOPEE

Facility Address:
1855 10TH AVENUE WEST
SHAKOPEE, MN
ZIP 55379
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Facility Phone Number: 952 856-7510

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1295064137

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	24D1029904
LAB Type	Assisted Living Facility
Facility Name	AUGUSTANA EMERALD CARE OF SHAKOPEE
Street	1855 10TH AVENUE WEST
City	SHAKOPEE
State	MN
ZIP	55379
Phone	952 856-7510
CertificateType	4
CertificateEffectiveDate	8/25/2022
CertificateExpirationDate	8/24/2024
FacilityType	Waiver

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