24D2167399 CLIA NUMBER - IMMACULATE HOME CARE LLC

Laboratory Demographics

  • CLIA Code: 24D2167399
  • Facility Name: IMMACULATE HOME CARE LLC
  • Facility Address: 1390 BEECH STREET
    SAINT PAUL, MN
    ZIP 55106
  • Facility Phone: (651) 666-2135
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: KAYODE K. TAIWO
  • NPI Number: 1407364813
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 24D2167399
LAB Type Assisted Living Facility
Facility Name IMMACULATE HOME CARE LLC
Street 1390 BEECH STREET
City SAINT PAUL
State MN
ZIP 55106
Phone 6516662135
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/6/2025
Certificate Expiration Date 6/5/2027
Facility Type Assisted Living Facility
Lab Director KAYODE K. TAIWO

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This page was last updated on: 6/29/2026