21D0874391 CLIA NUMBER - AUTUMN LAKE HEALTHCARE AT PARKVILLE

Laboratory Demographics

  • CLIA Code: 21D0874391
  • Facility Name: AUTUMN LAKE HEALTHCARE AT PARKVILLE
  • Facility Address: 8710 EMGE ROAD ATTENTION BOB HARRIS
    BALTIMORE, MD
    ZIP 21234
  • Facility Phone: 410 661-5955
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ZIAD MIRZA
  • NPI Number: 1063694529
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 21D0874391
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AUTUMN LAKE HEALTHCARE AT PARKVILLE
Street 8710 EMGE ROAD ATTENTION BOB HARRIS
City BALTIMORE
State MD
ZIP 21234
Phone 410 661-5955
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/6/2025
Certificate Expiration Date 8/5/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director ZIAD MIRZA

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