24D1067426 CLIA NUMBER - DIVINE HOUSE INC 2

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Field Name	Field Value
CLIA Number	24D1067426
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	DIVINE HOUSE INC 2
Street	2974 192ND ST
City	DAWSON
State	MN
ZIP	56232
Phone	320 441-7001
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	8/7/2024
Certificate Expiration Date	8/6/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	ELIZABETH HILLSTROM

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