24D1036605 CLIA NUMBER - THE PRAIRIE LODGE AT EARLE BROWN

Laboratory Demographics

  • CLIA Code: 24D1036605
  • Facility Name: THE PRAIRIE LODGE AT EARLE BROWN
  • Facility Address: 6001 EARLE BROWN DRIVE
    BROOKLYN CENTER, MN
    ZIP 55430
  • Facility Phone: 763 566-1495
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: TAMI HALEY
  • NPI Number: 1497969455
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D1036605
LAB Type Assisted Living Facility
Facility Name THE PRAIRIE LODGE AT EARLE BROWN
Street 6001 EARLE BROWN DRIVE
City BROOKLYN CENTER
State MN
ZIP 55430
Phone 763 566-1495
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 TAMI HALEY

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