24D2184066 CLIA NUMBER - TRANSFORMATION HOUSE

Laboratory Demographics

CLIA Number: 24D2184066

Facility Name: TRANSFORMATION HOUSE

Facility Address:
1410 S FERRY ROAD
ANOKA, MN
ZIP 55303
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Facility Phone Number: 763 427-7155

Facility Type: Other - SUBSTANCE ABUSE TREATMENT

Certificate Type: Waiver

NPI Number: 1114143989

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLIA Record

Field Name	Field Value
CLIA Number	24D2184066
LAB Type	Other - SUBSTANCE ABUSE TREATMENT
Facility Name	TRANSFORMATION HOUSE
Street	1410 S FERRY ROAD
City	ANOKA
State	MN
ZIP	55303
Phone	763 427-7155
CertificateType	4
CertificateEffectiveDate	5/14/2024
CertificateExpirationDate	5/13/2026
FacilityType	Waiver

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