21D2036158 CLIA NUMBER - GREEN RIDGE BEHAVIORAL HEALTH LLC

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Laboratory Demographics

CLIA Number: 21D2036158

Facility Name: GREEN RIDGE BEHAVIORAL HEALTH LLC

Facility Address:
610 PROFESSIONAL DRIVE STE 255
GAITHERSBURG, MD
ZIP 20879
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Facility Phone Number: 240 683-6202

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1609283050

Taxonomy: 2084N0400X - Psychiatry & Neurology
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.

CLIA Record

Field Name	Field Value
CLIA Number	21D2036158
LAB Type	Physician Office
Facility Name	GREEN RIDGE BEHAVIORAL HEALTH LLC
Street	610 PROFESSIONAL DRIVE STE 255
City	GAITHERSBURG
State	MD
ZIP	20879
Phone	240 683-6202
CertificateType	4
CertificateEffectiveDate	2/2/2024
CertificateExpirationDate	2/1/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024