21D2204828 CLIA NUMBER - GAUDENZIA INC OWINGS MILLS

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Laboratory Demographics

CLIA Number: 21D2204828

Facility Name: GAUDENZIA INC OWINGS MILLS

Facility Address:
10225 JENSEN LANE
OWINGS MILLS, MD
ZIP 21117
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Facility Phone Number: 443 681-0776

Facility Type: Other - RESIDENTIAL TX

Certificate Type: Waiver

NPI Number: 1265645493

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2204828
LAB Type	Other - RESIDENTIAL TX
Facility Name	GAUDENZIA INC OWINGS MILLS
Street	10225 JENSEN LANE
City	OWINGS MILLS
State	MD
ZIP	21117
Phone	443 681-0776
CertificateType	4
CertificateEffectiveDate	12/10/2022
CertificateExpirationDate	12/9/2024
FacilityType	Waiver

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