24D2249432 CLIA NUMBER - PINE RIVER GROUP HOME, INC

Laboratory Demographics

  • CLIA Code: 24D2249432
  • Facility Name: PINE RIVER GROUP HOME, INC
  • Facility Address: 103 5TH ST
    PINE RIVER, MN
    ZIP 56474
  • Facility Phone: 218 587-4888
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: CARRIE D. GUIDA
  • NPI Number: 1962851071
  • Taxonomy: 1223G0001X - Dentist

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2024
Certificate Expiration Date 1/19/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director CARRIE D. GUIDA

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