24D2167038 CLIA NUMBER - ACTIVE DAY OF MINNETONKA

Laboratory Demographics

CLIA Number: 24D2167038

Facility Name: ACTIVE DAY OF MINNETONKA

Facility Address:
10937 BREN RD E
MINNETONKA, MN
ZIP 55343
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Facility Phone Number: 215 642-6269

Facility Type: Other - ADULT DAY CARE

Certificate Type: Waiver

NPI Number: 1811490220

Taxonomy: 261QA0600X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D2167038
LAB Type	Other - ADULT DAY CARE
Facility Name	ACTIVE DAY OF MINNETONKA
Street	10937 BREN RD E
City	MINNETONKA
State	MN
ZIP	55343
Phone	215 642-6269
CertificateType	4
CertificateEffectiveDate	5/31/2023
CertificateExpirationDate	5/30/2025
FacilityType	Waiver

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