43D2110844 CLIA NUMBER - EDGEWOOD PRAIRIE CROSSINGS WATERTOWN IL LLC

Laboratory Demographics

  • CLIA Code: 43D2110844
  • Facility Name: EDGEWOOD PRAIRIE CROSSINGS WATERTOWN IL LLC
  • Facility Address: 901 14TH AVE NORTHEAST
    WATERTOWN, SD
    ZIP 57201
  • Facility Phone: 605 882-3084
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: CARRIE KWASNIEWSKI
  • NPI Number: 1326516501
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 43D2110844
LAB Type Assisted Living Facility
Facility Name EDGEWOOD PRAIRIE CROSSINGS WATERTOWN IL LLC
Street 901 14TH AVE NORTHEAST
City WATERTOWN
State SD
ZIP 57201
Phone 605 882-3084
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2024
Certificate Expiration Date 3/23/2026
Facility Type Assisted Living Facility
Lab Director CARRIE KWASNIEWSKI

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