21D2244216 CLIA NUMBER - HIS FAITHFULNESS FAMILY CLINIC

Laboratory Demographics

CLIA Number: 21D2244216

Facility Name: HIS FAITHFULNESS FAMILY CLINIC

Facility Address:
6188 OXON HILL RD SUITE 301
OXON HILL, MD
ZIP 20745
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Facility Phone Number: 301 247-2314

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1164030102

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	21D2244216
LAB Type	Practitioner Other
Facility Name	HIS FAITHFULNESS FAMILY CLINIC
Street	6188 OXON HILL RD SUITE 301
City	OXON HILL
State	MD
ZIP	20745
Phone	301 247-2314
CertificateType	4
CertificateEffectiveDate	11/30/2023
CertificateExpirationDate	11/29/2025
FacilityType	Waiver

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