24D2319608 CLIA NUMBER - GRACEFUL LIVING LLC

Laboratory Demographics

  • CLIA Code: 24D2319608
  • Facility Name: GRACEFUL LIVING LLC
  • Facility Address: 17862 ESSEX LN
    LAKEVILLE, MN
    ZIP 55044
  • Facility Phone: 612 472-2983
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: ALI M. ISTAHIL
  • NPI Number: 1982429221
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2319608
LAB Type Assisted Living Facility
Facility Name GRACEFUL LIVING LLC
Street 17862 ESSEX LN
City LAKEVILLE
State MN
ZIP 55044
Phone 612 472-2983
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Assisted Living Facility
Lab Director ALI M. ISTAHIL

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