24D1040587 CLIA NUMBER - LAKESIDE MANOR

Laboratory Demographics

  • CLIA Code: 24D1040587
  • Facility Name: LAKESIDE MANOR
  • Facility Address: 4831 LONDON ROAD
    DULUTH, MN
    ZIP 55804
  • Facility Phone: 218 525-2784
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: BRANDON MARTINSON
  • NPI Number: 1801968342
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 24D1040587
LAB Type Assisted Living Facility
Facility Name LAKESIDE MANOR
Street 4831 LONDON ROAD
City DULUTH
State MN
ZIP 55804
Phone 218 525-2784
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Assisted Living Facility
Lab Director BRANDON MARTINSON

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