21D2124079 CLIA NUMBER - MISHA HOUSE, LLC

Laboratory Demographics

  • CLIA Code: 21D2124079
  • Facility Name: MISHA HOUSE, LLC
  • Facility Address: 2300 GARRISON BLVD SUITE 120
    BALTIMORE, MD
    ZIP 21216
  • Facility Phone: 443 708-3054
  • Facility Type: Other - MENTAL HEALTH RECOVERY
  • Facility Type: Waiver
  • Lab Director: JANAY TAYLOR
  • NPI Number: 1164883344
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2124079
LAB Type Other - MENTAL HEALTH RECOVERY
Facility Name MISHA HOUSE, LLC
Street 2300 GARRISON BLVD SUITE 120
City BALTIMORE
State MD
ZIP 21216
Phone 443 708-3054
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2025
Certificate Expiration Date 1/9/2027
Facility Type Other - MENTAL HEALTH RECOVERY
Lab Director JANAY TAYLOR

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