24D2138614 CLIA NUMBER - PRIMUS INCORPORATED

Laboratory Demographics

CLIA Number: 24D2138614

Facility Name: PRIMUS INCORPORATED

Facility Address:
7309 KENTUCKY AVENUE NORTH
BROOKLYN PARK, MN
ZIP 55428
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Facility Phone Number: 763 732-3729

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1316494032

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name	Field Value
CLIA Number	24D2138614
LAB Type	Assisted Living Facility
Facility Name	PRIMUS INCORPORATED
Street	7309 KENTUCKY AVENUE NORTH
City	BROOKLYN PARK
State	MN
ZIP	55428
Phone	763 732-3729
CertificateType	4
CertificateEffectiveDate	10/23/2023
CertificateExpirationDate	10/22/2025
FacilityType	Waiver

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