35D0409074 CLIA NUMBER - ST LUKE'S HOME

Laboratory Demographics

  • CLIA Code: 35D0409074
  • Facility Name: ST LUKE'S HOME
  • Facility Address: 242 10TH ST W
    DICKINSON, ND
    ZIP 58601
  • Facility Phone: 701 456-8250
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JAMIE KOFFLER
  • NPI Number: 1912466947
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 35D0409074
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name ST LUKE'S HOME
Street 242 10TH ST W
City DICKINSON
State ND
ZIP 58601
Phone 701 456-8250
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JAMIE KOFFLER

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