24D2319964 CLIA NUMBER - GRACEFUL LIVING MANOR LLC

Laboratory Demographics

  • CLIA Code: 24D2319964
  • Facility Name: GRACEFUL LIVING MANOR LLC
  • Facility Address: 2624 BLAISDELL AVE
    MINNEAPOLIS, MN
    ZIP 55408
  • Facility Phone: 952 256-4008
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: ABDIRIZAK ABDULAHI
  • NPI Number: 1407745201
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2319964
LAB Type Assisted Living Facility
Facility Name GRACEFUL LIVING MANOR LLC
Street 2624 BLAISDELL AVE
City MINNEAPOLIS
State MN
ZIP 55408
Phone 952 256-4008
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2025
Certificate Expiration Date 3/10/2027
Facility Type Assisted Living Facility
Lab Director ABDIRIZAK ABDULAHI

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