24D2305002 CLIA NUMBER - JABEZ CUSTOMIZED LIVING SERVICES

Laboratory Demographics

  • CLIA Code: 24D2305002
  • Facility Name: JABEZ CUSTOMIZED LIVING SERVICES
  • Facility Address: 1417 BROOKDALE DR
    BROOKLYN PARK, MN
    ZIP 55444
  • Facility Phone: 612 272-8009
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: PANDORA L. WHITE
  • NPI Number: 1487136206
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 24D2305002
LAB Type Assisted Living Facility
Facility Name JABEZ CUSTOMIZED LIVING SERVICES
Street 1417 BROOKDALE DR
City BROOKLYN PARK
State MN
ZIP 55444
Phone 612 272-8009
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2024
Certificate Expiration Date 5/21/2026
Facility Type Assisted Living Facility
Lab Director PANDORA L. WHITE

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