24D2049467 CLIA NUMBER - FAMILY ADVOCACY CENTER OF NORTHERN MINNESOTA

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Laboratory Demographics

CLIA Number: 24D2049467

Facility Name: FAMILY ADVOCACY CENTER OF NORTHERN MINNESOTA

Facility Address:
800 BEMIDJI AVENUE NORTH, SUITE 4
BEMIDJI, MN
ZIP 56601
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Facility Phone Number: 218 333-6156

Facility Type: Other - SEXUAL ASSAULT NURSE EXAM

Certificate Type: Waiver

NPI Number: 1568534576

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	24D2049467
LAB Type	Other - SEXUAL ASSAULT NURSE EXAM
Facility Name	FAMILY ADVOCACY CENTER OF NORTHERN MINNESOTA
Street	800 BEMIDJI AVENUE NORTH, SUITE 4
City	BEMIDJI
State	MN
ZIP	56601
Phone	218 333-6156
CertificateType	4
CertificateEffectiveDate	11/7/2022
CertificateExpirationDate	11/6/2024
FacilityType	Waiver

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