24D1037844 CLIA NUMBER - WILDWOOD GROVE

Laboratory Demographics

  • CLIA Code: 24D1037844
  • Facility Name: WILDWOOD GROVE
  • Facility Address: 410 EAST MAIN STREET
    LE ROY, MN
    ZIP 55951
  • Facility Phone: 507 324-9515
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: KARI MENSINK
  • NPI Number: 1184833394
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D1037844
LAB Type Assisted Living Facility
Facility Name WILDWOOD GROVE
Street 410 EAST MAIN STREET
City LE ROY
State MN
ZIP 55951
Phone 507 324-9515
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2025
Certificate Expiration Date 3/6/2027
Facility Type Assisted Living Facility
Lab Director KARI MENSINK

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