21D2176503 CLIA NUMBER - REHOBOTH MEDICAL CENTER LLC

Laboratory Demographics

CLIA Number: 21D2176503

Facility Name: REHOBOTH MEDICAL CENTER LLC

Facility Address:
11223 LOCKWOOD DRIVE
SILVER SPRING, MD
ZIP 20901
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Facility Phone Number: 240 254-3375

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1356980270

Taxonomy: 363LP2300X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	21D2176503
LAB Type	Practitioner Other
Facility Name	REHOBOTH MEDICAL CENTER LLC
Street	11223 LOCKWOOD DRIVE
City	SILVER SPRING
State	MD
ZIP	20901
Phone	240 254-3375
CertificateType	4
CertificateEffectiveDate	12/17/2023
CertificateExpirationDate	12/16/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024