24D1037012 CLIA NUMBER - CENTENNIAL HOUSE OF APPLE VALLEY

Laboratory Demographics

  • CLIA Code: 24D1037012
  • Facility Name: CENTENNIAL HOUSE OF APPLE VALLEY
  • Facility Address: 14625 PENNOCK AVENUE
    APPLE VALLEY, MN
    ZIP 55124
  • Facility Phone: 952 891-2711
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: TAMI HALEY
  • NPI Number: 1538373048
  • Taxonomy: 310400000X - Assisted Living Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 24D1037012
LAB Type Other
Facility Name CENTENNIAL HOUSE OF APPLE VALLEY
Street 14625 PENNOCK AVENUE
City APPLE VALLEY
State MN
ZIP 55124
Phone 952 891-2711
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/14/2025
Certificate Expiration Date 2/13/2027
Facility Type Other
Lab Director TAMI HALEY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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