21D2099639 CLIA NUMBER - SHINE SENIOR CENTER

Laboratory Demographics

  • CLIA Code: 21D2099639
  • Facility Name: SHINE SENIOR CENTER
  • Facility Address: 9198 RED BRANCH RD STE H
    COLUMBIA, MD
    ZIP 21045
  • Facility Phone: 301 310-3067
  • Facility Type: Other - ADULT MEDICAL DAY CARE
  • Facility Type: Waiver
  • Lab Director: SUNGWON JANG
  • NPI Number: 1700261633
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2099639
LAB Type Other - ADULT MEDICAL DAY CARE
Facility Name SHINE SENIOR CENTER
Street 9198 RED BRANCH RD STE H
City COLUMBIA
State MD
ZIP 21045
Phone 301 310-3067
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Other - ADULT MEDICAL DAY CARE
Lab Director SUNGWON JANG

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