24D2096260 CLIA NUMBER - ECUMEN DETROIT LAKES HOME CARE

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Laboratory Demographics

CLIA Number: 24D2096260

Facility Name: ECUMEN DETROIT LAKES HOME CARE

Facility Address:
1435 MADISON AVE
DETROIT LAKES, MN
ZIP 56501
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Facility Phone Number: 218 844-9437

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1871165142

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	24D2096260
LAB Type	Home Health Agency
Facility Name	ECUMEN DETROIT LAKES HOME CARE
Street	1435 MADISON AVE
City	DETROIT LAKES
State	MN
ZIP	56501
Phone	218 844-9437
CertificateType	4
CertificateEffectiveDate	5/19/2023
CertificateExpirationDate	5/18/2025
FacilityType	Waiver

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