24D2305136 CLIA NUMBER - WALNUT GROVE

Laboratory Demographics

  • CLIA Code: 24D2305136
  • Facility Name: WALNUT GROVE
  • Facility Address: 13708 PORTLAND AVE S
    BURNSVILLE, MN
    ZIP 55337
  • Facility Phone: 320 223-9249
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: DARLA THAO
  • NPI Number: 1104603299
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2305136
LAB Type Assisted Living Facility
Facility Name WALNUT GROVE
Street 13708 PORTLAND AVE S
City BURNSVILLE
State MN
ZIP 55337
Phone 320 223-9249
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2024
Certificate Expiration Date 5/23/2026
Facility Type Assisted Living Facility
Lab Director DARLA THAO

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