21D2060415 CLIA NUMBER - CLOSUP I, INC DBA EDENTON RETIREMENT COMMUNITY

Laboratory Demographics

  • CLIA Code: 21D2060415
  • Facility Name: CLOSUP I, INC DBA EDENTON RETIREMENT COMMUNITY
  • Facility Address: 5800 GENESIS LANE
    FREDERICK, MD
    ZIP 21703
  • Facility Phone: 301 694-3100
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: TIARA Y. WEEDON
  • NPI Number: 1962484857
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 21D2060415
LAB Type Assisted Living Facility
Facility Name CLOSUP I, INC DBA EDENTON RETIREMENT COMMUNITY
Street 5800 GENESIS LANE
City FREDERICK
State MD
ZIP 21703
Phone 301 694-3100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2025
Certificate Expiration Date 6/10/2027
Facility Type Assisted Living Facility
Lab Director TIARA Y. WEEDON

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