24D2327274 CLIA NUMBER - CRYSTAL EDGE 2 LLC

Laboratory Demographics

  • CLIA Code: 24D2327274
  • Facility Name: CRYSTAL EDGE 2 LLC
  • Facility Address: 1979 WILSON AVE
    SAINT PAUL, MN
    ZIP 55119
  • Facility Phone: 612 459-2724
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: UCHE HAJA
  • NPI Number: 1841016458
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 24D2327274
LAB Type Assisted Living Facility
Facility Name CRYSTAL EDGE 2 LLC
Street 1979 WILSON AVE
City SAINT PAUL
State MN
ZIP 55119
Phone 612 459-2724
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/21/2025
Certificate Expiration Date 7/20/2027
Facility Type Assisted Living Facility
Lab Director UCHE HAJA

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