21D2204823 CLIA NUMBER - GAUDENZIA INC PARK HEIGHTS

Laboratory Demographics

  • CLIA Code: 21D2204823
  • Facility Name: GAUDENZIA INC PARK HEIGHTS
  • Facility Address: 4615 PARK HEIGHTS AVE
    BALTIMORE, MD
    ZIP 21215
  • Facility Phone: 443 681-0776
  • Facility Type: Other - RESIDENTIAL TX
  • Facility Type: Waiver
  • Lab Director: KRISTY BLALOCK
  • NPI Number: 1215256417
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 21D2204823
LAB Type Other - RESIDENTIAL TX
Facility Name GAUDENZIA INC PARK HEIGHTS
Street 4615 PARK HEIGHTS AVE
City BALTIMORE
State MD
ZIP 21215
Phone 443 681-0776
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/10/2024
Certificate Expiration Date 12/9/2026
Facility Type Other - RESIDENTIAL TX
Lab Director KRISTY BLALOCK

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