24D1036514 CLIA NUMBER - BROOKSTONE MANOR

Laboratory Demographics

  • CLIA Code: 24D1036514
  • Facility Name: BROOKSTONE MANOR
  • Facility Address: 722 N POKEGAMA AVE
    GRAND RAPIDS, MN
    ZIP 55744
  • Facility Phone: 218 999-7672
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JENNIFER MIKOS
  • NPI Number: 1588176432
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D1036514
LAB Type Assisted Living Facility
Facility Name BROOKSTONE MANOR
Street 722 N POKEGAMA AVE
City GRAND RAPIDS
State MN
ZIP 55744
Phone 218 999-7672
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2025
Certificate Expiration Date 2/3/2027
Facility Type Assisted Living Facility
Lab Director JENNIFER MIKOS

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