21D2097314 CLIA NUMBER - EVERGREEN ADULT MEDICAL DAY CARE

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Laboratory Demographics

CLIA Number: 21D2097314

Facility Name: EVERGREEN ADULT MEDICAL DAY CARE

Facility Address:
9290 GAITHER ROAD
GAITHERSBURG, MD
ZIP 20877
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Facility Phone Number: 301 527-1100

Facility Type: Other - ADULT MED DAY CARE

Certificate Type: Waiver

NPI Number: 1932582715

Taxonomy: 261QA0600X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2097314
LAB Type	Other - ADULT MED DAY CARE
Facility Name	EVERGREEN ADULT MEDICAL DAY CARE
Street	9290 GAITHER ROAD
City	GAITHERSBURG
State	MD
ZIP	20877
Phone	301 527-1100
CertificateType	4
CertificateEffectiveDate	6/12/2023
CertificateExpirationDate	6/11/2025
FacilityType	Waiver

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