24D2069387 CLIA NUMBER - DUNGARVIN MINNESOTA LLC - BALBRIGGEN

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Laboratory Demographics

CLIA Number: 24D2069387

Facility Name: DUNGARVIN MINNESOTA LLC - BALBRIGGEN

Facility Address:
1270 LARPENTEUR AVENUE
SAINT PAUL, MN
ZIP 55109
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Facility Phone Number: 651 699-6050

Facility Type: Other - SUPERVISED LVG FACILITY

Certificate Type: Waiver

NPI Number: 1235122003

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name	Field Value
CLIA Number	24D2069387
LAB Type	Other - SUPERVISED LVG FACILITY
Facility Name	DUNGARVIN MINNESOTA LLC - BALBRIGGEN
Street	1270 LARPENTEUR AVENUE
City	SAINT PAUL
State	MN
ZIP	55109
Phone	651 699-6050
CertificateType	4
CertificateEffectiveDate	11/22/2023
CertificateExpirationDate	11/21/2025
FacilityType	Waiver

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