09D2143479 CLIA NUMBER - WHOLISTIC HOME & COMMUNITY BASED

Laboratory Demographics

  • CLIA Code: 09D2143479
  • Facility Name: WHOLISTIC HOME & COMMUNITY BASED
  • Facility Address: 1449 ROXANNA ROAD, NW
    WASHINGTON, DC
    ZIP 20012
  • Facility Phone: 202 347-5334
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: MIATTA N. THOMAS
  • NPI Number: 1720119407
  • Taxonomy: 251C00000X - Day Training, Developmentally Disabled Services

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CLIA Record

Field Name Field Value
CLIA Number 09D2143479
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name WHOLISTIC HOME & COMMUNITY BASED
Street 1449 ROXANNA ROAD, NW
City WASHINGTON
State DC
ZIP 20012
Phone 202 347-5334
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2024
Certificate Expiration Date 10/22/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director MIATTA N. THOMAS

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