35D0951705 CLIA NUMBER - PSJ ACQUISITION, LLC DBA PRAIRIE ST JOHN'S

Laboratory Demographics

  • CLIA Code: 35D0951705
  • Facility Name: PSJ ACQUISITION, LLC DBA PRAIRIE ST JOHN'S
  • Facility Address: 510 4TH ST S
    FARGO, ND
    ZIP 58103
  • Facility Phone: 701 476-7200
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: KEITH BREILAND
  • NPI Number: 1679709802
  • Taxonomy: 283Q00000X - Psychiatric Hospital

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CLIA Record

Field Name Field Value
CLIA Number 35D0951705
LAB Type Hospital
Facility Name PSJ ACQUISITION, LLC DBA PRAIRIE ST JOHN'S
Street 510 4TH ST S
City FARGO
State ND
ZIP 58103
Phone 701 476-7200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2025
Certificate Expiration Date 8/31/2027
Facility Type Hospital
Lab Director KEITH BREILAND

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