24D2281099 CLIA NUMBER - AFFECT PROVIDER GROUP, PSC

Laboratory Demographics

  • CLIA Code: 24D2281099
  • Facility Name: AFFECT PROVIDER GROUP, PSC
  • Facility Address: 6385 OLD SHADY OAK RD, SUITE 250, OFFICE 273
    EDEN PRAIRIE, MN
    ZIP 55344
  • Facility Phone: 845 769-8758
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: DOUG ELWOOD
  • NPI Number: 1326799081
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2281099
LAB Type Comp. Outpatient Rehab Facility
Facility Name AFFECT PROVIDER GROUP, PSC
Street 6385 OLD SHADY OAK RD, SUITE 250, OFFICE 273
City EDEN PRAIRIE
State MN
ZIP 55344
Phone 845 769-8758
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2025
Certificate Expiration Date 5/1/2027
Facility Type Comp. Outpatient Rehab Facility
Lab Director DOUG ELWOOD

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This page was last updated on: 6/4/2025