24D2133695 CLIA NUMBER - OLIVE GROVE HOSPICE

Laboratory Demographics

  • CLIA Code: 24D2133695
  • Facility Name: OLIVE GROVE HOSPICE
  • Facility Address: 12402 JAMESTOWN ST NE SUITE #200
    BLAINE, MN
    ZIP 55449
  • Facility Phone: 651 287-0265
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: STACY LOPEZ
  • NPI Number: 1871024794
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 24D2133695
LAB Type Hospice
Facility Name OLIVE GROVE HOSPICE
Street 12402 JAMESTOWN ST NE SUITE #200
City BLAINE
State MN
ZIP 55449
Phone 651 287-0265
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2025
Certificate Expiration Date 7/17/2027
Facility Type Hospice
Lab Director STACY LOPEZ

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