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