24D2025497 CLIA NUMBER - BOUNDARY WATERS CARE CENTER

Laboratory Demographics

  • CLIA Code: 24D2025497
  • Facility Name: BOUNDARY WATERS CARE CENTER
  • Facility Address: 200 WEST CONAN STREET
    ELY, MN
    ZIP 55731
  • Facility Phone: 218 365-8705
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SHARLENE DETZEL
  • NPI Number: 1477660777
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2025497
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BOUNDARY WATERS CARE CENTER
Street 200 WEST CONAN STREET
City ELY
State MN
ZIP 55731
Phone 218 365-8705
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2025
Certificate Expiration Date 6/9/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director SHARLENE DETZEL

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