21D2237390 CLIA NUMBER - ALL GRACE MEDICAL CLINIC LLC

Laboratory Demographics

CLIA Number: 21D2237390

Facility Name: ALL GRACE MEDICAL CLINIC LLC

Facility Address:
3951 FERRARA DR
SILVER SPRING, MD
ZIP 20906
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Facility Phone Number: 240 669-8653

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1053902916

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2237390
LAB Type	Practitioner Other
Facility Name	ALL GRACE MEDICAL CLINIC LLC
Street	3951 FERRARA DR
City	SILVER SPRING
State	MD
ZIP	20906
Phone	240 669-8653
CertificateType	4
CertificateEffectiveDate	9/24/2023
CertificateExpirationDate	9/23/2025
FacilityType	Waiver

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