24D1036600 CLIA NUMBER - AMHERST H WILDER FOUNDATION CUSTOMIZED LIVING

Laboratory Demographics

  • CLIA Code: 24D1036600
  • Facility Name: AMHERST H WILDER FOUNDATION CUSTOMIZED LIVING
  • Facility Address: 935 LAFOND AVENUE
    SAINT PAUL, MN
    ZIP 55104
  • Facility Phone: 651 280-2500
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MAUREEN KENNEY
  • NPI Number: 1790851863
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D1036600
LAB Type Assisted Living Facility
Facility Name AMHERST H WILDER FOUNDATION CUSTOMIZED LIVING
Street 935 LAFOND AVENUE
City SAINT PAUL
State MN
ZIP 55104
Phone 651 280-2500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2025
Certificate Expiration Date 2/6/2027
Facility Type Assisted Living Facility
Lab Director MAUREEN KENNEY

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