24D2150784 CLIA NUMBER - PETERSON COLONIAL HOMES, INC

Laboratory Demographics

  • CLIA Code: 24D2150784
  • Facility Name: PETERSON COLONIAL HOMES, INC
  • Facility Address: 4723 NYGAARD RD
    BROOKSTON, MN
    ZIP 55711
  • Facility Phone: 218 878-0642
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: BRADLEY M. ECKEL
  • NPI Number: 1104037985
  • Taxonomy: 3104A0625X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2150784
LAB Type Assisted Living Facility
Facility Name PETERSON COLONIAL HOMES, INC
Street 4723 NYGAARD RD
City BROOKSTON
State MN
ZIP 55711
Phone 218 878-0642
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/3/2024
Certificate Expiration Date 7/2/2026
Facility Type Assisted Living Facility
Lab Director BRADLEY M. ECKEL

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