24D2034618 CLIA NUMBER - EBENEZER HOME CARE

Laboratory Demographics

CLIA Number: 24D2034618

Facility Name: EBENEZER HOME CARE

Facility Address:
2625 PARK AVENUE
MINNEAPOLIS, MN
ZIP 55407
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Facility Phone Number: 612 871-4574

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1356636344

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 24D2034618
LAB Type Home Health Agency
Facility Name EBENEZER HOME CARE
Street 2625 PARK AVENUE
City MINNEAPOLIS
State MN
ZIP 55407
Phone 612 871-4574
CertificateType 4
CertificateEffectiveDate 12/29/2023
CertificateExpirationDate 12/28/2025
FacilityType Waiver

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