24D2181663 CLIA NUMBER - RISE UP HEALTH CLINICS

Laboratory Demographics

CLIA Number: 24D2181663

Facility Name: RISE UP HEALTH CLINICS

Facility Address:
5045 DIVISION AVE
WHITE BEAR LAKE, MN
ZIP 55110
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Facility Phone Number: 651 260-1596

Facility Type: Other - SCHOOL BASED HEALTH CENTE

Certificate Type: Waiver

NPI Number: 1063094878

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	24D2181663
LAB Type	Other - SCHOOL BASED HEALTH CENTE
Facility Name	RISE UP HEALTH CLINICS
Street	5045 DIVISION AVE
City	WHITE BEAR LAKE
State	MN
ZIP	55110
Phone	651 260-1596
CertificateType	4
CertificateEffectiveDate	4/8/2024
CertificateExpirationDate	4/7/2026
FacilityType	Waiver

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