24D2120727 CLIA NUMBER - PRAIRIECARE 610 MEDICAL BUILDING

Laboratory Demographics

  • CLIA Code: 24D2120727
  • Facility Name: PRAIRIECARE 610 MEDICAL BUILDING
  • Facility Address: 5500 94TH AVE N
    BROOKLYN PARK, MN
    ZIP 55443
  • Facility Phone: 763 762-8837
  • Facility Type: Other - BEHAVIORAL HEALTH
  • Facility Type: Waiver
  • Lab Director: DR. CHRISTOPHER WALL
  • NPI Number: 1215182928
  • Taxonomy: 283Q00000X - Psychiatric Hospital

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CLIA Record

Field Name Field Value
CLIA Number 24D2120727
LAB Type Other - BEHAVIORAL HEALTH
Facility Name PRAIRIECARE 610 MEDICAL BUILDING
Street 5500 94TH AVE N
City BROOKLYN PARK
State MN
ZIP 55443
Phone 763 762-8837
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/24/2024
Certificate Expiration Date 10/23/2026
Facility Type Other - BEHAVIORAL HEALTH
Lab Director DR. CHRISTOPHER WALL

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