24D2016753 CLIA NUMBER - PEDIATRIC HOME SERVICE PRIVATE DUTY NURSING SVC

Laboratory Demographics

  • CLIA Code: 24D2016753
  • Facility Name: PEDIATRIC HOME SERVICE PRIVATE DUTY NURSING SVC
  • Facility Address: 2800 CLEVELAND AVENUE N
    ROSEVILLE, MN
    ZIP 55113
  • Facility Phone: 651 642-1825
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: JOYCE BULMAN
  • NPI Number: 1225701014
  • Taxonomy: 251E00000X - Home Health

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 24D2016753
LAB Type Home Health Agency
Facility Name PEDIATRIC HOME SERVICE PRIVATE DUTY NURSING SVC
Street 2800 CLEVELAND AVENUE N
City ROSEVILLE
State MN
ZIP 55113
Phone 651 642-1825
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/24/2024
Certificate Expiration Date 11/23/2026
Facility Type Home Health Agency
Lab Director JOYCE BULMAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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