24D1080417 CLIA NUMBER - MAPLE GROVE DIALYSIS UNIT

Laboratory Demographics

  • CLIA Code: 24D1080417
  • Facility Name: MAPLE GROVE DIALYSIS UNIT
  • Facility Address: 15655 GROVE CIRCLE NORTH
    MAPLE GROVE, MN
    ZIP 55369
  • Facility Phone: 615 341-6793
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MARY TAHNK JOHNSON
  • NPI Number: 1427432087
  • Taxonomy: 1041C0700X - Social Worker

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CLIA Record

Field Name Field Value
CLIA Number 24D1080417
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MAPLE GROVE DIALYSIS UNIT
Street 15655 GROVE CIRCLE NORTH
City MAPLE GROVE
State MN
ZIP 55369
Phone 615 341-6793
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2024
Certificate Expiration Date 2/21/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MARY TAHNK JOHNSON

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