24D2271291 CLIA NUMBER - BROOKLYN CENTER, MARY T

Laboratory Demographics

  • CLIA Code: 24D2271291
  • Facility Name: BROOKLYN CENTER, MARY T
  • Facility Address: 507 69TH AVE N
    BROOKLYN CENTER, MN
    ZIP 55430
  • Facility Phone: 763 754-2505
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: CHRISTINE ZAKI
  • NPI Number: 1639811557
  • Taxonomy: 106S00000X - Behavior Technician

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CLIA Record

Field Name Field Value
CLIA Number 24D2271291
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name BROOKLYN CENTER, MARY T
Street 507 69TH AVE N
City BROOKLYN CENTER
State MN
ZIP 55430
Phone 763 754-2505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director CHRISTINE ZAKI

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