24D2168994 CLIA NUMBER - MERCY CARE HOME

Laboratory Demographics

CLIA Number: 24D2168994

Facility Name: MERCY CARE HOME

Facility Address:
5005 WOODLAND RD
MINNETONKA, MN
ZIP 55345
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Facility Phone Number: 612 226-0533

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1902361280

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	24D2168994
LAB Type	Assisted Living Facility
Facility Name	MERCY CARE HOME
Street	5005 WOODLAND RD
City	MINNETONKA
State	MN
ZIP	55345
Phone	612 226-0533
CertificateType	4
CertificateEffectiveDate	7/13/2023
CertificateExpirationDate	7/12/2025
FacilityType	Waiver

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