24D2131052 CLIA NUMBER - DIVINE CARE LLC

Laboratory Demographics

  • CLIA Code: 24D2131052
  • Facility Name: DIVINE CARE LLC
  • Facility Address: 16125 HYLAND AVE
    LAKEVILLE, MN
    ZIP 55044
  • Facility Phone: 612 423-9765
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: FENTEZIA ZEWDIE
  • NPI Number: 1548586191
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 24D2131052
LAB Type Home Health Agency
Facility Name DIVINE CARE LLC
Street 16125 HYLAND AVE
City LAKEVILLE
State MN
ZIP 55044
Phone 612 423-9765
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2025
Certificate Expiration Date 5/21/2027
Facility Type Home Health Agency
Lab Director FENTEZIA ZEWDIE

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