24D2037417 CLIA NUMBER - HENRY HAGEN HAGEN RESIDENCE

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Field Name	Field Value
CLIA Number	24D2037417
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	HENRY HAGEN HAGEN RESIDENCE
Street	19545 LILLEHEI DRIVE
City	HASTINGS
State	MN
ZIP	55033
Phone	651 437-9363
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	2/27/2024
Certificate Expiration Date	2/26/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	JOLYNN MICHALSKI

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