24D2216046 CLIA NUMBER - GENTLE HAVEN LLC

Laboratory Demographics

  • CLIA Code: 24D2216046
  • Facility Name: GENTLE HAVEN LLC
  • Facility Address: 8045 159TH STREET WEST
    APPLE VALLEY, MN
    ZIP 55124
  • Facility Phone: 612 913-9934
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JARED N. OMBOI
  • NPI Number: 1154941128
  • Taxonomy: 251J00000X - Nursing Care

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CLIA Record

Field Name Field Value
CLIA Number 24D2216046
LAB Type Assisted Living Facility
Facility Name GENTLE HAVEN LLC
Street 8045 159TH STREET WEST
City APPLE VALLEY
State MN
ZIP 55124
Phone 612 913-9934
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2025
Certificate Expiration Date 3/8/2027
Facility Type Assisted Living Facility
Lab Director JARED N. OMBOI

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