24D2032776 CLIA NUMBER - LAKE MINNETONKA SHORES ASSISTED LIVING COMMONS/ARBOR

Laboratory Demographics

  • CLIA Code: 24D2032776
  • Facility Name: LAKE MINNETONKA SHORES ASSISTED LIVING COMMONS/ARBOR
  • Facility Address: 4559 SHORELINE DRIVE
    SPRING PARK, MN
    ZIP 55384
  • Facility Phone: 952 471-6088
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MARY HARTMAN-BENJAMIN
  • NPI Number: 1679997480
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2032776
LAB Type Assisted Living Facility
Facility Name LAKE MINNETONKA SHORES ASSISTED LIVING COMMONS/ARBOR
Street 4559 SHORELINE DRIVE
City SPRING PARK
State MN
ZIP 55384
Phone 952 471-6088
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2023
Certificate Expiration Date 11/14/2025
Facility Type Assisted Living Facility
Lab Director MARY HARTMAN-BENJAMIN

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