24D2180893 CLIA NUMBER - GRACE ASSISTED LIVING LLC

Laboratory Demographics

  • CLIA Code: 24D2180893
  • Facility Name: GRACE ASSISTED LIVING LLC
  • Facility Address: 2566 112TH AVE NW
    COON RAPIDS, MN
    ZIP 55433
  • Facility Phone: 612 888-1277
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: KEFYALEW F. AMANTE
  • NPI Number: 1952947269
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2180893
LAB Type Assisted Living Facility
Facility Name GRACE ASSISTED LIVING LLC
Street 2566 112TH AVE NW
City COON RAPIDS
State MN
ZIP 55433
Phone 612 888-1277
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/23/2024
Certificate Expiration Date 3/22/2026
Facility Type Assisted Living Facility
Lab Director KEFYALEW F. AMANTE

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