21D0209957 CLIA NUMBER - AUTUMN LAKE HEALTHCARE AT CHERRY LANE

Laboratory Demographics

  • CLIA Code: 21D0209957
  • Facility Name: AUTUMN LAKE HEALTHCARE AT CHERRY LANE
  • Facility Address: 9001 CHERRY LANE
    LAUREL, MD
    ZIP 20708
  • Facility Phone: 301 498-8558
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: NADER TAVAKOLI
  • NPI Number: 1629572508
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 21D0209957
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AUTUMN LAKE HEALTHCARE AT CHERRY LANE
Street 9001 CHERRY LANE
City LAUREL
State MD
ZIP 20708
Phone 301 498-8558
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director NADER TAVAKOLI

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This page was last updated on: 3/20/2025