24D2115966 CLIA NUMBER - RESIDENTIAL CARE AT NINE MILE CREEK

Laboratory Demographics

CLIA Number: 24D2115966

Facility Name: RESIDENTIAL CARE AT NINE MILE CREEK

Facility Address:
10641 JAMES ROAD
BLOOMINGTON, MN
ZIP 55431
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Facility Phone Number: 952 229-4213

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1154794089

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	24D2115966
LAB Type	Assisted Living Facility
Facility Name	RESIDENTIAL CARE AT NINE MILE CREEK
Street	10641 JAMES ROAD
City	BLOOMINGTON
State	MN
ZIP	55431
Phone	952 229-4213
CertificateType	4
CertificateEffectiveDate	7/15/2022
CertificateExpirationDate	7/14/2024
FacilityType	Waiver

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