24D2091799 CLIA NUMBER - PROSPER INC DBA RED RIVER RECOVERY CENTER

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Laboratory Demographics

CLIA Number: 24D2091799

Facility Name: PROSPER INC DBA RED RIVER RECOVERY CENTER

Facility Address:
701 CENTER AVE E
DILWORTH, MN
ZIP 56529
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Facility Phone Number: 218 284-7772

Facility Type: Other - RESIDENTIAL SUBSTANCE USE

Certificate Type: Waiver

NPI Number: 1275045718

Taxonomy: 261QR0800X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D2091799
LAB Type	Other - RESIDENTIAL SUBSTANCE USE
Facility Name	PROSPER INC DBA RED RIVER RECOVERY CENTER
Street	701 CENTER AVE E
City	DILWORTH
State	MN
ZIP	56529
Phone	218 284-7772
CertificateType	4
CertificateEffectiveDate	2/19/2023
CertificateExpirationDate	2/18/2025
FacilityType	Waiver

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