24D2195816 CLIA NUMBER - THE LODGES OF BROOKLYN PARK

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Laboratory Demographics

CLIA Number: 24D2195816

Facility Name: THE LODGES OF BROOKLYN PARK

Facility Address:
7719 HUMBOLDT AVE NORTH
BROOKLYN PARK, MN
ZIP 55444
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Facility Phone Number: 612 200-0901

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1649669193

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	24D2195816
LAB Type	Assisted Living Facility
Facility Name	THE LODGES OF BROOKLYN PARK
Street	7719 HUMBOLDT AVE NORTH
City	BROOKLYN PARK
State	MN
ZIP	55444
Phone	612 200-0901
CertificateType	4
CertificateEffectiveDate	10/13/2022
CertificateExpirationDate	10/12/2024
FacilityType	Waiver

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