24D2185383 CLIA NUMBER - GRACEFUL LODGE HOME CARE LLC

Laboratory Demographics

  • CLIA Code: 24D2185383
  • Facility Name: GRACEFUL LODGE HOME CARE LLC
  • Facility Address: 6430 JUNE AVE N
    BROOKLYN CENTER, MN
    ZIP 55429
  • Facility Phone: 763 496-0956
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: DANIEL BREWER
  • NPI Number: 1629616289
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 24D2185383
LAB Type Assisted Living Facility
Facility Name GRACEFUL LODGE HOME CARE LLC
Street 6430 JUNE AVE N
City BROOKLYN CENTER
State MN
ZIP 55429
Phone 763 496-0956
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2024
Certificate Expiration Date 6/2/2026
Facility Type Assisted Living Facility
Lab Director DANIEL BREWER

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