24D2054081 CLIA NUMBER - BLOOMINGTON, MARY T

Laboratory Demographics

  • CLIA Code: 24D2054081
  • Facility Name: BLOOMINGTON, MARY T
  • Facility Address: 10633 KELL AVE S
    BLOOMINGTON, MN
    ZIP 55437
  • Facility Phone: 763 754-2505
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: CHRISTINE ZAKI
  • NPI Number: 1205148178
  • Taxonomy: 152W00000X - Optometrist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 24D2054081
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name BLOOMINGTON, MARY T
Street 10633 KELL AVE S
City BLOOMINGTON
State MN
ZIP 55437
Phone 763 754-2505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director CHRISTINE ZAKI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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