24D1099523 CLIA NUMBER - MARY T HOSPICE

Laboratory Demographics

  • CLIA Code: 24D1099523
  • Facility Name: MARY T HOSPICE
  • Facility Address: 11777 XEON BLVD NW
    COON RAPIDS, MN
    ZIP 55448
  • Facility Phone: 763 772-9963
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: LISA MADSEN
  • NPI Number: 1629214515
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 24D1099523
LAB Type Hospice
Facility Name MARY T HOSPICE
Street 11777 XEON BLVD NW
City COON RAPIDS
State MN
ZIP 55448
Phone 763 772-9963
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2025
Certificate Expiration Date 5/14/2027
Facility Type Hospice
Lab Director LISA MADSEN

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