21D0879983 CLIA NUMBER - AUTUMN LAKE HEALTHCARE AT SPA CREEK

Laboratory Demographics

  • CLIA Code: 21D0879983
  • Facility Name: AUTUMN LAKE HEALTHCARE AT SPA CREEK
  • Facility Address: 35 MILKSHAKE LANE
    ANNAPOLIS, MD
    ZIP 21403
  • Facility Phone: 410 269-5100
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: ELLEN B. CASSIDY MD
  • NPI Number: 1083896559
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 21D0879983
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AUTUMN LAKE HEALTHCARE AT SPA CREEK
Street 35 MILKSHAKE LANE
City ANNAPOLIS
State MD
ZIP 21403
Phone 410 269-5100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2023
Certificate Expiration Date 12/2/2025
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director ELLEN B. CASSIDY MD

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