21D2107453 CLIA NUMBER - IMANI HOUSE MEDICAL SERVICES

Laboratory Demographics

  • CLIA Code: 21D2107453
  • Facility Name: IMANI HOUSE MEDICAL SERVICES
  • Facility Address: 6101 PARK HEIGHTS AVENUE SUITE D1
    BALTIMORE, MD
    ZIP 21215
  • Facility Phone: 410 624-7190
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANNETTE KINGEL
  • NPI Number: 1184233595
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 21D2107453
LAB Type Physician Office
Facility Name IMANI HOUSE MEDICAL SERVICES
Street 6101 PARK HEIGHTS AVENUE SUITE D1
City BALTIMORE
State MD
ZIP 21215
Phone 410 624-7190
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/14/2024
Certificate Expiration Date 1/13/2026
Facility Type Physician Office
Lab Director ANNETTE KINGEL

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