24D2067609 CLIA NUMBER - EDGEWOOD BLAINE SENIOR LIVING, LLC

Laboratory Demographics

  • CLIA Code: 24D2067609
  • Facility Name: EDGEWOOD BLAINE SENIOR LIVING, LLC
  • Facility Address: 12450 CLOUD DRIVE NE
    BLAINE, MN
    ZIP 55449
  • Facility Phone: 218 230-5019
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: STACY APRIL
  • NPI Number: 1396167953
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2067609
LAB Type Assisted Living Facility
Facility Name EDGEWOOD BLAINE SENIOR LIVING, LLC
Street 12450 CLOUD DRIVE NE
City BLAINE
State MN
ZIP 55449
Phone 218 230-5019
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2025
Certificate Expiration Date 10/20/2027
Facility Type Assisted Living Facility
Lab Director STACY APRIL

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