24D2273024 CLIA NUMBER - CHILDREN'S MINNESOTA PARTIAL HOSPITALIZATION PROGRAM-ROSEVILLE

Laboratory Demographics

CLIA Number: 24D2273024

Facility Name: CHILDREN'S MINNESOTA PARTIAL HOSPITALIZATION PROGRAM-ROSEVILLE

Facility Address:
2990 CENTRE POINT DRIVE
ROSEVILLE, MN
ZIP 55113
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Facility Phone Number: 952 992-6755

Facility Type: Other - PARTIAL HOSP PSYCHIATRIC

Certificate Type: Waiver

NPI Number: 1912004631

Taxonomy: 261QR0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D2273024
LAB Type	Other - PARTIAL HOSP PSYCHIATRIC
Facility Name	CHILDREN'S MINNESOTA PARTIAL HOSPITALIZATION PROGRAM-ROSEVILLE
Street	2990 CENTRE POINT DRIVE
City	ROSEVILLE
State	MN
ZIP	55113
Phone	952 992-6755
CertificateType	4
CertificateEffectiveDate	12/6/2022
CertificateExpirationDate	12/5/2024
FacilityType	Waiver

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