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24D2299091 CLIA NUMBER - DESTINY HOME CARE SERVICES, INC CHICAGO

Laboratory Demographics

CLIA Number: 24D2299091

Facility Name: DESTINY HOME CARE SERVICES, INC CHICAGO

Facility Address:
9318 CHICAGO AVENUE SOUTH
BLOOMINGTON, MN
ZIP 55420
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Facility Phone Number: 952 888-7172

Facility Type: Assisted Living Facility

Certificate Type: Waiver
NPI Number: 1841422524

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 24D2299091
LAB Type Assisted Living Facility
Facility Name DESTINY HOME CARE SERVICES, INC CHICAGO
Street 9318 CHICAGO AVENUE SOUTH
City BLOOMINGTON
State MN
ZIP 55420
Phone 952 888-7172
CertificateType 4
CertificateEffectiveDate 2/13/2024
CertificateExpirationDate 2/12/2026
FacilityType Waiver

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