24D1042490 CLIA NUMBER - PHOENIX RESIDENCE NEWPORT

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Field Name	Field Value
CLIA Number	24D1042490
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	PHOENIX RESIDENCE NEWPORT
Street	351 14TH STREET
City	NEWPORT
State	MN
ZIP	55055
Phone	651 459-4419
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	4/12/2024
Certificate Expiration Date	4/11/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	KIMBERLY E. HUMAN

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