24D2307580 CLIA NUMBER - GENTLE HAVEN LLC

Laboratory Demographics

  • CLIA Code: 24D2307580
  • Facility Name: GENTLE HAVEN LLC
  • Facility Address: 15768 CARDINAL CIR
    ROSEMOUNT, MN
    ZIP 55068
  • Facility Phone: 612 913-9934
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: JARED N. OMBOI
  • NPI Number: 1073375788
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2307580
LAB Type Assisted Living Facility
Facility Name GENTLE HAVEN LLC
Street 15768 CARDINAL CIR
City ROSEMOUNT
State MN
ZIP 55068
Phone 612 913-9934
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2024
Certificate Expiration Date 7/10/2026
Facility Type Assisted Living Facility
Lab Director JARED N. OMBOI

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