24D2155589 CLIA NUMBER - PRAHA VILLAGE

Laboratory Demographics

CLIA Number: 24D2155589

Facility Name: PRAHA VILLAGE

Facility Address:
1100 1ST STREET SE
NEW PRAGUE, MN
ZIP 56071
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Facility Phone Number: 952 855-8855

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1992279533

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	24D2155589
LAB Type	Assisted Living Facility
Facility Name	PRAHA VILLAGE
Street	1100 1ST STREET SE
City	NEW PRAGUE
State	MN
ZIP	56071
Phone	952 855-8855
CertificateType	4
CertificateEffectiveDate	10/2/2022
CertificateExpirationDate	10/1/2024
FacilityType	Waiver

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