24D1106358 CLIA NUMBER - RANGE CENTER INC

Laboratory Demographics

CLIA Number: 24D1106358

Facility Name: RANGE CENTER INC

Facility Address:
1001 NW 8TH AVENUE
CHISHOLM, MN
ZIP 55719
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Facility Phone Number: 218 254-3347

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1932260650

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	24D1106358
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	RANGE CENTER INC
Street	1001 NW 8TH AVENUE
City	CHISHOLM
State	MN
ZIP	55719
Phone	218 254-3347
CertificateType	4
CertificateEffectiveDate	10/12/2023
CertificateExpirationDate	10/11/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024