24D2188982 CLIA NUMBER - GATHERWELL

Laboratory Demographics

  • CLIA Code: 24D2188982
  • Facility Name: GATHERWELL
  • Facility Address: 17565 CENTRAL AVE NE
    HAM LAKE, MN
    ZIP 55304
  • Facility Phone: 612 806-1546
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: SARAH M. BROWN
  • NPI Number: 1649855479
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2188982
LAB Type Mobile Laboratory
Facility Name GATHERWELL
Street 17565 CENTRAL AVE NE
City HAM LAKE
State MN
ZIP 55304
Phone 612 806-1546
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2024
Certificate Expiration Date 7/23/2026
Facility Type Mobile Laboratory
Lab Director SARAH M. BROWN

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