21D2170476 CLIA NUMBER - ACT HEALTH INTEGRATED SERVICES, LLC

Laboratory Demographics

  • CLIA Code: 21D2170476
  • Facility Name: ACT HEALTH INTEGRATED SERVICES, LLC
  • Facility Address: 800 S FREDERICK AVE #208
    GAITHERSBURG, MD
    ZIP 20877
  • Facility Phone: 301 679-5770
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARY F. BOATENG
  • NPI Number: 1871088641
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2170476
LAB Type Physician Office
Facility Name ACT HEALTH INTEGRATED SERVICES, LLC
Street 800 S FREDERICK AVE #208
City GAITHERSBURG
State MD
ZIP 20877
Phone 301 679-5770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2025
Certificate Expiration Date 8/12/2027
Facility Type Physician Office
Lab Director MARY F. BOATENG

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