35D2107702 CLIA NUMBER - 4TH CORPORATION

Laboratory Demographics

  • CLIA Code: 35D2107702
  • Facility Name: 4TH CORPORATION
  • Facility Address: 120 11TH ST
    NEW ROCKFORD, ND
    ZIP 58356
  • Facility Phone: 701 947-2147
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: KODI KELLER
  • NPI Number: 1114527322
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 35D2107702
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name 4TH CORPORATION
Street 120 11TH ST
City NEW ROCKFORD
State ND
ZIP 58356
Phone 701 947-2147
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2024
Certificate Expiration Date 1/19/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director KODI KELLER

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