24D2211216 CLIA NUMBER - HAVENWOOD OF MAPLE GROVE

Laboratory Demographics

  • CLIA Code: 24D2211216
  • Facility Name: HAVENWOOD OF MAPLE GROVE
  • Facility Address: 18695 73RD AVENUE NORTH
    MAPLE GROVE, MN
    ZIP 55311
  • Facility Phone: 612 800-0405
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JOELLA M. BROWN
  • NPI Number: 1598416430
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2211216
LAB Type Assisted Living Facility
Facility Name HAVENWOOD OF MAPLE GROVE
Street 18695 73RD AVENUE NORTH
City MAPLE GROVE
State MN
ZIP 55311
Phone 612 800-0405
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2025
Certificate Expiration Date 1/25/2027
Facility Type Assisted Living Facility
Lab Director JOELLA M. BROWN

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