24D2292517 CLIA NUMBER - EVYGABS HEALTHCARE SYSTEMS LLC

Laboratory Demographics

  • CLIA Code: 24D2292517
  • Facility Name: EVYGABS HEALTHCARE SYSTEMS LLC
  • Facility Address: 20604 ENFIELD AVE N
    FOREST LAKE, MN
    ZIP 55025
  • Facility Phone: 651 315-9629
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: EVELINE MDA
  • NPI Number: 1396266128
  • Taxonomy: 163W00000X - Registered Nurse

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CLIA Record

Field Name Field Value
CLIA Number 24D2292517
LAB Type Assisted Living Facility
Facility Name EVYGABS HEALTHCARE SYSTEMS LLC
Street 20604 ENFIELD AVE N
City FOREST LAKE
State MN
ZIP 55025
Phone 651 315-9629
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Assisted Living Facility
Lab Director EVELINE MDA

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