21D0887046 CLIA NUMBER - AUTUMN LAKE HEALTHCARE AT ALICE MANOR

Laboratory Demographics

  • CLIA Code: 21D0887046
  • Facility Name: AUTUMN LAKE HEALTHCARE AT ALICE MANOR
  • Facility Address: 2095 ROCKROSE AVE
    BALTIMORE, MD
    ZIP 21211
  • Facility Phone: 410 889-9700
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: IBRAHIM M. RIZQUI
  • NPI Number: 1720494313
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 21D0887046
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name AUTUMN LAKE HEALTHCARE AT ALICE MANOR
Street 2095 ROCKROSE AVE
City BALTIMORE
State MD
ZIP 21211
Phone 410 889-9700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2024
Certificate Expiration Date 6/2/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director IBRAHIM M. RIZQUI

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