24D2291709 CLIA NUMBER - HIGH DRIVE CUSTOMIZED/ASSISTED LIVING LLC

Laboratory Demographics

  • CLIA Code: 24D2291709
  • Facility Name: HIGH DRIVE CUSTOMIZED/ASSISTED LIVING LLC
  • Facility Address: 13813 HIGH DRIVE
    BURNSVILLE, MN
    ZIP 55337
  • Facility Phone: 763 228-2804
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: ANBASSA H. BUKULA
  • NPI Number: 1013605518
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2291709
LAB Type Assisted Living Facility
Facility Name HIGH DRIVE CUSTOMIZED/ASSISTED LIVING LLC
Street 13813 HIGH DRIVE
City BURNSVILLE
State MN
ZIP 55337
Phone 763 228-2804
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2023
Certificate Expiration Date 10/15/2025
Facility Type Assisted Living Facility
Lab Director ANBASSA H. BUKULA

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