24D2076752 CLIA NUMBER - SAGE PRAIRIE RECOVERY

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Laboratory Demographics

CLIA Number: 24D2076752

Facility Name: SAGE PRAIRIE RECOVERY

Facility Address:
13005 COUNTY ROAD 5
BURNSVILLE, MN
ZIP 55337
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Facility Phone Number: 651 829-7124

Facility Type: Other - CHEMICAL DEPENDENCY

Certificate Type: Waiver

NPI Number: 1720406168

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D2076752
LAB Type	Other - CHEMICAL DEPENDENCY
Facility Name	SAGE PRAIRIE RECOVERY
Street	13005 COUNTY ROAD 5
City	BURNSVILLE
State	MN
ZIP	55337
Phone	651 829-7124
CertificateType	4
CertificateEffectiveDate	4/25/2022
CertificateExpirationDate	4/24/2024
FacilityType	Waiver

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