24D2108289 CLIA NUMBER - THE LODGE IN MENDOTA

Laboratory Demographics

CLIA Number: 24D2108289

Facility Name: THE LODGE IN MENDOTA

Facility Address:
664 FREEWAY ROAD
MENDOTA HEIGHTS, MN
ZIP 55118
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Facility Phone Number: 612 200-0901

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1649669193

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	24D2108289
LAB Type	Assisted Living Facility
Facility Name	THE LODGE IN MENDOTA
Street	664 FREEWAY ROAD
City	MENDOTA HEIGHTS
State	MN
ZIP	55118
Phone	612 200-0901
CertificateType	4
CertificateEffectiveDate	2/2/2024
CertificateExpirationDate	2/1/2026
FacilityType	Waiver

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