24D2195241 CLIA NUMBER - AMAZING GRACE HEALTH LLC

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Laboratory Demographics

CLIA Number: 24D2195241

Facility Name: AMAZING GRACE HEALTH LLC

Facility Address:
625 SNELLING AVENUE N, UNIT A
SAINT PAUL, MN
ZIP 55104
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Facility Phone Number: 952 288-9921

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1568002160

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	24D2195241
LAB Type	Physician Office
Facility Name	AMAZING GRACE HEALTH LLC
Street	625 SNELLING AVENUE N, UNIT A
City	SAINT PAUL
State	MN
ZIP	55104
Phone	952 288-9921
CertificateType	4
CertificateEffectiveDate	10/7/2022
CertificateExpirationDate	10/6/2024
FacilityType	Waiver

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