24D2139156 CLIA NUMBER - PROVIDENCE VILLA

Laboratory Demographics

  • CLIA Code: 24D2139156
  • Facility Name: PROVIDENCE VILLA
  • Facility Address: 200 MINNESOTA AVE EAST
    SEBEKA, MN
    ZIP 56477
  • Facility Phone: 218 837-5497
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: ANDREW C. HUHTA
  • NPI Number: 1003305723
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2139156
LAB Type Assisted Living Facility
Facility Name PROVIDENCE VILLA
Street 200 MINNESOTA AVE EAST
City SEBEKA
State MN
ZIP 56477
Phone 218 837-5497
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2023
Certificate Expiration Date 10/30/2025
Facility Type Assisted Living Facility
Lab Director ANDREW C. HUHTA

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