24D2252360 CLIA NUMBER - WEST BLOOMINGTON RESIDENCE

Laboratory Demographics

  • CLIA Code: 24D2252360
  • Facility Name: WEST BLOOMINGTON RESIDENCE
  • Facility Address: 10441 JOHNSON AVENUE SOUTH
    BLOOMINGTON, MN
    ZIP 55437
  • Facility Phone: 763 550-1774
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: SANDRA K. HORTON
  • NPI Number: 1366566572
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2252360
LAB Type Assisted Living Facility
Facility Name WEST BLOOMINGTON RESIDENCE
Street 10441 JOHNSON AVENUE SOUTH
City BLOOMINGTON
State MN
ZIP 55437
Phone 763 550-1774
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2024
Certificate Expiration Date 2/9/2026
Facility Type Assisted Living Facility
Lab Director SANDRA K. HORTON

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