24D1042979 CLIA NUMBER - SPRING GROVE ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 24D1042979
  • Facility Name: SPRING GROVE ASSISTED LIVING
  • Facility Address: 130 5TH AVE SE
    SPRING GROVE, MN
    ZIP 55974
  • Facility Phone: 507 498-4000
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: NIKKI KIMMERLE
  • NPI Number: 1184715971
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D1042979
LAB Type Assisted Living Facility
Facility Name SPRING GROVE ASSISTED LIVING
Street 130 5TH AVE SE
City SPRING GROVE
State MN
ZIP 55974
Phone 507 498-4000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/13/2025
Certificate Expiration Date 7/12/2027
Facility Type Assisted Living Facility
Lab Director NIKKI KIMMERLE

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