24D2184791 CLIA NUMBER - AFFINITY RESIDENTIAL CARE HOME

Laboratory Demographics

CLIA Number: 24D2184791

Facility Name: AFFINITY RESIDENTIAL CARE HOME

Facility Address:
9213 ELLIOT AVE SOUTH
BLOOMINGTON, MN
ZIP 55420
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Facility Phone Number: 952 417-6368

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1548817620

Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

CLIA Record

Field Name	Field Value
CLIA Number	24D2184791
LAB Type	Assisted Living Facility
Facility Name	AFFINITY RESIDENTIAL CARE HOME
Street	9213 ELLIOT AVE SOUTH
City	BLOOMINGTON
State	MN
ZIP	55420
Phone	952 417-6368
CertificateType	4
CertificateEffectiveDate	5/26/2022
CertificateExpirationDate	5/25/2024
FacilityType	Waiver

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