24D2287398 CLIA NUMBER - ST CROIX HOSPICE-ST CLOUD

Laboratory Demographics

CLIA Number: 24D2287398

Facility Name: ST CROIX HOSPICE-ST CLOUD

Facility Address:
3315 ROOSEVELT RD, STE 400
SAINT CLOUD, MN
ZIP 56301
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Facility Phone Number: 320 201-5930

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1689368144

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	24D2287398
LAB Type	Hospice
Facility Name	ST CROIX HOSPICE-ST CLOUD
Street	3315 ROOSEVELT RD, STE 400
City	SAINT CLOUD
State	MN
ZIP	56301
Phone	320 201-5930
CertificateType	4
CertificateEffectiveDate	8/14/2023
CertificateExpirationDate	8/13/2025
FacilityType	Waiver

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