21D2123579 CLIA NUMBER - FENWICK LANDING SENIOR CARE COMMUNITY

Laboratory Demographics

  • CLIA Code: 21D2123579
  • Facility Name: FENWICK LANDING SENIOR CARE COMMUNITY
  • Facility Address: 11665 DOOLITTLE DRIVE
    WALDORF, MD
    ZIP 20602
  • Facility Phone: 240 245-0616
  • Facility Type: Other - MEDICAL ADULT DAY CARE
  • Facility Type: Waiver
  • Lab Director: PHILLIP WISOTSKY
  • NPI Number: 1194844720
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2123579
LAB Type Other - MEDICAL ADULT DAY CARE
Facility Name FENWICK LANDING SENIOR CARE COMMUNITY
Street 11665 DOOLITTLE DRIVE
City WALDORF
State MD
ZIP 20602
Phone 240 245-0616
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2024
Certificate Expiration Date 12/26/2026
Facility Type Other - MEDICAL ADULT DAY CARE
Lab Director PHILLIP WISOTSKY

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