24D1032350 CLIA NUMBER - MEADOWS ON FAIRVIEW EBENEZER LAKES ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 24D1032350
  • Facility Name: MEADOWS ON FAIRVIEW EBENEZER LAKES ASSISTED LIVING
  • Facility Address: 25565 FAIRVIEW AVENUE
    WYOMING, MN
    ZIP 55092
  • Facility Phone: 651 982-6228
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: GRETCHEN BLAUFUSS
  • NPI Number: 1679916571
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D1032350
LAB Type Assisted Living Facility
Facility Name MEADOWS ON FAIRVIEW EBENEZER LAKES ASSISTED LIVING
Street 25565 FAIRVIEW AVENUE
City WYOMING
State MN
ZIP 55092
Phone 651 982-6228
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2024
Certificate Expiration Date 10/20/2026
Facility Type Assisted Living Facility
Lab Director GRETCHEN BLAUFUSS

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