24D1084162 CLIA NUMBER - HAWTHORNE HOUSE INC

Laboratory Demographics

  • CLIA Code: 24D1084162
  • Facility Name: HAWTHORNE HOUSE INC
  • Facility Address: 6931 COUNTRY CLUB DRIVE
    GOLDEN VALLEY, MN
    ZIP 55427
  • Facility Phone: 612 385-9200
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: SUSANTHI R. FERNANDO
  • NPI Number: 1891976841
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D1084162
LAB Type Assisted Living Facility
Facility Name HAWTHORNE HOUSE INC
Street 6931 COUNTRY CLUB DRIVE
City GOLDEN VALLEY
State MN
ZIP 55427
Phone 612 385-9200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2024
Certificate Expiration Date 5/15/2026
Facility Type Assisted Living Facility
Lab Director SUSANTHI R. FERNANDO

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