24D2186805 CLIA NUMBER - NEXUS OF HOPE PSYCHIATRY & MENTAL HEALTH WELLNESS PLLC

Laboratory Demographics

CLIA Number: 24D2186805

Facility Name: NEXUS OF HOPE PSYCHIATRY & MENTAL HEALTH WELLNESS PLLC

Facility Address:
10527 165TH STREET W
LAKEVILLE, MN
ZIP 55044
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Facility Phone Number: 952 955-7080

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1407315096

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D2186805
LAB Type	Practitioner Other
Facility Name	NEXUS OF HOPE PSYCHIATRY & MENTAL HEALTH WELLNESS PLLC
Street	10527 165TH STREET W
City	LAKEVILLE
State	MN
ZIP	55044
Phone	952 955-7080
CertificateType	4
CertificateEffectiveDate	6/22/2022
CertificateExpirationDate	6/21/2024
FacilityType	Waiver

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