24D2274747 CLIA NUMBER - FAIRHAVENS HOME CARE LLC

Laboratory Demographics

  • CLIA Code: 24D2274747
  • Facility Name: FAIRHAVENS HOME CARE LLC
  • Facility Address: 2608 87TH TRAIL N
    BROOKLYN PARK, MN
    ZIP 55443
  • Facility Phone: 763 222-4746
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: EMEKA OKAFOR
  • NPI Number: 1417342494
  • Taxonomy: 251J00000X - Nursing Care

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CLIA Record

Field Name Field Value
CLIA Number 24D2274747
LAB Type Home Health Agency
Facility Name FAIRHAVENS HOME CARE LLC
Street 2608 87TH TRAIL N
City BROOKLYN PARK
State MN
ZIP 55443
Phone 763 222-4746
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2025
Certificate Expiration Date 1/9/2027
Facility Type Home Health Agency
Lab Director EMEKA OKAFOR

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