24D2034383 CLIA NUMBER - SENIOR CLASS COMMUNITY

Laboratory Demographics

CLIA Number: 24D2034383

Facility Name: SENIOR CLASS COMMUNITY

Facility Address:
4451 EAST WOODMAN STREET
PEQUOT LAKES, MN
ZIP 56472
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Facility Phone Number: 218 316-2542

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1437791845

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 24D2034383
LAB Type Assisted Living Facility
Facility Name SENIOR CLASS COMMUNITY
Street 4451 EAST WOODMAN STREET
City PEQUOT LAKES
State MN
ZIP 56472
Phone 218 316-2542
CertificateType 4
CertificateEffectiveDate 12/22/2023
CertificateExpirationDate 12/21/2025
FacilityType Waiver

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