24D2077978 CLIA NUMBER - GLENCOE DIALYSIS

Laboratory Demographics

  • CLIA Code: 24D2077978
  • Facility Name: GLENCOE DIALYSIS
  • Facility Address: 1123 HENNEPIN AVE
    GLENCOE, MN
    ZIP 55336
  • Facility Phone: (320) 864-1901
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: RAJEEV KAUL
  • NPI Number: 1982023560
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2077978
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GLENCOE DIALYSIS
Street 1123 HENNEPIN AVE
City GLENCOE
State MN
ZIP 55336
Phone 3208641901
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2026
Certificate Expiration Date 5/19/2028
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director RAJEEV KAUL

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This page was last updated on: 5/18/2026