24D2108896 CLIA NUMBER - PRAIRIECARE LLC

Laboratory Demographics

  • CLIA Code: 24D2108896
  • Facility Name: PRAIRIECARE LLC
  • Facility Address: 2001 BEAM AVE
    MAPLEWOOD, MN
    ZIP 55109
  • Facility Phone: 763 383-5800
  • Facility Type: Other - MENTAL HEALTH CLINIC
  • Facility Type: Waiver
  • Lab Director: DR. CHRISTOPHER WALL
  • NPI Number: 1629353495
  • Taxonomy: 283Q00000X - Psychiatric Hospital

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CLIA Record

Field Name Field Value
CLIA Number 24D2108896
LAB Type Other - MENTAL HEALTH CLINIC
Facility Name PRAIRIECARE LLC
Street 2001 BEAM AVE
City MAPLEWOOD
State MN
ZIP 55109
Phone 763 383-5800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2024
Certificate Expiration Date 2/15/2026
Facility Type Other - MENTAL HEALTH CLINIC
Lab Director DR. CHRISTOPHER WALL

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This page was last updated on: 9/29/2025