24D2249432 CLIA NUMBER - PINE RIVER GROUP HOME, INC

Laboratory Demographics

CLIA Number: 24D2249432

Facility Name: PINE RIVER GROUP HOME, INC

Facility Address:
103 5TH ST
PINE RIVER, MN
ZIP 56474
Get Directions

Facility Phone Number: 218 587-4888

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1962851071

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	24D2249432
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	PINE RIVER GROUP HOME, INC
Street	103 5TH ST
City	PINE RIVER
State	MN
ZIP	56474
Phone	218 587-4888
CertificateType	4
CertificateEffectiveDate	1/20/2024
CertificateExpirationDate	1/19/2026
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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