24D2306469 CLIA NUMBER - EVIDENT SOCIAL SERVICES

Laboratory Demographics

  • CLIA Code: 24D2306469
  • Facility Name: EVIDENT SOCIAL SERVICES
  • Facility Address: 1558 EAST 80TH ST
    BLOOMINGTON, MN
    ZIP 55425
  • Facility Phone: 651 300-0140
  • Facility Type: Other - INTENSIVE RESIDENTIAL TRE
  • Facility Type: Waiver
  • Lab Director: NCHE MOUBAYONG
  • NPI Number: 1649058652
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2306469
LAB Type Other - INTENSIVE RESIDENTIAL TRE
Facility Name EVIDENT SOCIAL SERVICES
Street 1558 EAST 80TH ST
City BLOOMINGTON
State MN
ZIP 55425
Phone 651 300-0140
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/18/2024
Certificate Expiration Date 6/17/2026
Facility Type Other - INTENSIVE RESIDENTIAL TRE
Lab Director NCHE MOUBAYONG

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