24D2207504 CLIA NUMBER - MISSION GROUP HOME LLC

Laboratory Demographics

  • CLIA Code: 24D2207504
  • Facility Name: MISSION GROUP HOME LLC
  • Facility Address: 6730 EWING AVE N
    BROOKLYN CENTER, MN
    ZIP 55429
  • Facility Phone: 507 210-5357
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: MOHAMED HASSAN
  • NPI Number: 1902428287
  • Taxonomy: 374U00000X - Home Health Aide

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CLIA Record

Field Name Field Value
CLIA Number 24D2207504
LAB Type Assisted Living Facility
Facility Name MISSION GROUP HOME LLC
Street 6730 EWING AVE N
City BROOKLYN CENTER
State MN
ZIP 55429
Phone 507 210-5357
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/29/2024
Certificate Expiration Date 12/28/2026
Facility Type Assisted Living Facility
Lab Director MOHAMED HASSAN

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