24D2154728 CLIA NUMBER - BEACON HOME OF WEDGEWOOD CENTRAL

Laboratory Demographics

  • CLIA Code: 24D2154728
  • Facility Name: BEACON HOME OF WEDGEWOOD CENTRAL
  • Facility Address: 3602 MOUNT VERNON CT
    WOODBURY, MN
    ZIP 55129
  • Facility Phone: 651 348-2236
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: AUTUMN OSTERGAARD
  • NPI Number: 1942650619
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2154728
LAB Type Assisted Living Facility
Facility Name BEACON HOME OF WEDGEWOOD CENTRAL
Street 3602 MOUNT VERNON CT
City WOODBURY
State MN
ZIP 55129
Phone 651 348-2236
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2024
Certificate Expiration Date 9/17/2026
Facility Type Assisted Living Facility
Lab Director AUTUMN OSTERGAARD

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