24D1102321 CLIA NUMBER - OLD MAIN VILLAGE

Laboratory Demographics

  • CLIA Code: 24D1102321
  • Facility Name: OLD MAIN VILLAGE
  • Facility Address: 301 SOUTH FIFTH STREET
    MANKATO, MN
    ZIP 56001
  • Facility Phone: 507 388-4200
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: SARAH LOPEZ
  • NPI Number: 1225189624
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D1102321
LAB Type Assisted Living Facility
Facility Name OLD MAIN VILLAGE
Street 301 SOUTH FIFTH STREET
City MANKATO
State MN
ZIP 56001
Phone 507 388-4200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/16/2025
Certificate Expiration Date 7/15/2027
Facility Type Assisted Living Facility
Lab Director SARAH LOPEZ

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