PHS/ COTTAGE GROVE
NPI 1164848362
Assisted Living Facility in Cottage Grove, MN
- Organization
- Assisted Living Facility
- CLIA Number: 24D2032751
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 11-14-2027
About PHS/ COTTAGE GROVE
This page provides the complete NPI Profile along with additional information for Phs/ Cottage Grove, a provider established in Cottage Grove, Minnesota operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1164848362 assigned on March 2014. The practitioner's primary taxonomy code is 310400000X with license number 357333 (MN). The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Mr. Mark Meyer (Cfo)
- NPI
- 1164848362 Verify this NPI
- Provider Name
- PHS/ COTTAGE GROVE
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 8200 HADLEY AVE S COTTAGE GROVE, MN 55016
- Location Phone
- (651) 769-6600
- Mailing Address
- 2845 HAMLINE AVE N ROSEVILLE, MN 55113
- Mailing Phone
- (651) 631-6432
- Mailing Fax
- (651) 631-6122
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-12-2014
- Last Update Date
- 11-11-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 357333
- License State
- MN
- Taxonomy Description
- A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 24D2032751
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- November 15, 2025
- Certificate Expiration Date
- November 14, 2027
- Laboratory Director
- EJIO EGI
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Phs/ Cottage Grove to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for PHS/ COTTAGE GROVE
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164848362, enumerated as an "organization" on March 12, 2014.
The provider is located at 8200 HADLEY AVE S COTTAGE GROVE, MN 55016 and the phone number is (651) 769-6600.
Assisted Living Facility with taxonomy code 310400000X.
