24D1046874 CLIA NUMBER - BROOKSIDE ASSISTED LIVING

Laboratory Demographics

CLIA Number: 24D1046874

Facility Name: BROOKSIDE ASSISTED LIVING

Facility Address:
2729 STATE 371 SW
PINE RIVER, MN
ZIP 56474
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Facility Phone Number: 218 242-2498

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1629338686

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	24D1046874
LAB Type	Assisted Living Facility
Facility Name	BROOKSIDE ASSISTED LIVING
Street	2729 STATE 371 SW
City	PINE RIVER
State	MN
ZIP	56474
Phone	218 242-2498
CertificateType	4
CertificateEffectiveDate	10/20/2023
CertificateExpirationDate	10/19/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024