24D2179689 CLIA NUMBER - FIRST LIGHT RESIDENTIAL CARE LLC

Laboratory Demographics

  • CLIA Code: 24D2179689
  • Facility Name: FIRST LIGHT RESIDENTIAL CARE LLC
  • Facility Address: 2935 AQUILA AVE S
    SAINT LOUIS PARK, MN
    ZIP 55426
  • Facility Phone: 952 314-1216
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: SHAMSO HASSAN
  • NPI Number: 1386297547
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2179689
LAB Type Home Health Agency
Facility Name FIRST LIGHT RESIDENTIAL CARE LLC
Street 2935 AQUILA AVE S
City SAINT LOUIS PARK
State MN
ZIP 55426
Phone 952 314-1216
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/29/2024
Certificate Expiration Date 2/27/2026
Facility Type Home Health Agency
Lab Director SHAMSO HASSAN

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