09D0912761 CLIA NUMBER - CARROLL MANOR NURSING AND REHAB CENTER AT PROVIDENCE HOSPITAL

Laboratory Demographics

  • CLIA Code: 09D0912761
  • Facility Name: CARROLL MANOR NURSING AND REHAB CENTER AT PROVIDENCE HOSPITAL
  • Facility Address: 1150 VARNUM STREET NE
    WASHINGTON, DC
    ZIP 20017
  • Facility Phone: 202 269-7100
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: MS. TINA SANDRI
  • NPI Number: 1598736753
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 09D0912761
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name CARROLL MANOR NURSING AND REHAB CENTER AT PROVIDENCE HOSPITAL
Street 1150 VARNUM STREET NE
City WASHINGTON
State DC
ZIP 20017
Phone 202 269-7100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2024
Certificate Expiration Date 3/11/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director MS. TINA SANDRI

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