21D2256838 CLIA NUMBER - HEARTWOOD PROGRAM, LLC, THE

Laboratory Demographics

CLIA Number: 21D2256838

Facility Name: HEARTWOOD PROGRAM, LLC, THE

Facility Address:
4350 EAST WEST HWY, SUITE 201
BETHESDA, MD
ZIP 20814
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Facility Phone Number: 301 970-4010

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1467962605

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2256838
LAB Type	Physician Office
Facility Name	HEARTWOOD PROGRAM, LLC, THE
Street	4350 EAST WEST HWY, SUITE 201
City	BETHESDA
State	MD
ZIP	20814
Phone	301 970-4010
CertificateType	4
CertificateEffectiveDate	3/29/2024
CertificateExpirationDate	3/28/2026
FacilityType	Waiver

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