21D2139244 CLIA NUMBER - ADORATION HOME HEALTH CARE MD LLC DBA REVIVAL HOME

Laboratory Demographics

  • CLIA Code: 21D2139244
  • Facility Name: ADORATION HOME HEALTH CARE MD LLC DBA REVIVAL HOME
  • Facility Address: 1101 MERCANTILE LANE SUITE 292
    UPPER MARLBORO, MD
    ZIP 20774
  • Facility Phone: 301 899-6070
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: MOUSTAFA S. SHAMMA MD
  • NPI Number: 1811194061
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 21D2139244
LAB Type Home Health Agency
Facility Name ADORATION HOME HEALTH CARE MD LLC DBA REVIVAL HOME
Street 1101 MERCANTILE LANE SUITE 292
City UPPER MARLBORO
State MD
ZIP 20774
Phone 301 899-6070
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2023
Certificate Expiration Date 10/31/2025
Facility Type Home Health Agency
Lab Director MOUSTAFA S. SHAMMA MD

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This page was last updated on: 6/4/2025