21D2040215 CLIA NUMBER - CHARLES CO DETENTION CTR C/O PRIMECARE MEDICAL INC

Laboratory Demographics

  • CLIA Code: 21D2040215
  • Facility Name: CHARLES CO DETENTION CTR C/O PRIMECARE MEDICAL INC
  • Facility Address: 6905 CRAIN HIGHWAY
    LA PLATA, MD
    ZIP 20646
  • Facility Phone: 301 932-3092
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: LEON S. MALACHINSKI
  • NPI Number: 1811155369
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2040215
LAB Type Prison
Facility Name CHARLES CO DETENTION CTR C/O PRIMECARE MEDICAL INC
Street 6905 CRAIN HIGHWAY
City LA PLATA
State MD
ZIP 20646
Phone 301 932-3092
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/18/2025
Certificate Expiration Date 1/17/2027
Facility Type Prison
Lab Director LEON S. MALACHINSKI

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