21D0885002 CLIA NUMBER - AUTUMN LAKE HEALTHCARE AT BRIDGEPARK

Laboratory Demographics

  • CLIA Code: 21D0885002
  • Facility Name: AUTUMN LAKE HEALTHCARE AT BRIDGEPARK
  • Facility Address: 4017 LIBERTY HEIGHTS AVE
    BALTIMORE, MD
    ZIP 21207
  • Facility Phone: 410 542-5306
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: NARENDER BHARAJ
  • NPI Number: 1831696509
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 21D0885002
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AUTUMN LAKE HEALTHCARE AT BRIDGEPARK
Street 4017 LIBERTY HEIGHTS AVE
City BALTIMORE
State MD
ZIP 21207
Phone 410 542-5306
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/14/2024
Certificate Expiration Date 4/13/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director NARENDER BHARAJ

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