24D2198337 CLIA NUMBER - NORMANDALE HOME

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Laboratory Demographics

CLIA Number: 24D2198337

Facility Name: NORMANDALE HOME

Facility Address:
5620 W 99TH ST SOUTH
BLOOMINGTON, MN
ZIP 55438
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Facility Phone Number: 612 644-0643

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1265763338

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D2198337
LAB Type	Assisted Living Facility
Facility Name	NORMANDALE HOME
Street	5620 W 99TH ST SOUTH
City	BLOOMINGTON
State	MN
ZIP	55438
Phone	612 644-0643
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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