21D2282566 CLIA NUMBER - LIFE INC ADULT MEDICAL DAY CENTER

Laboratory Demographics

  • CLIA Code: 21D2282566
  • Facility Name: LIFE INC ADULT MEDICAL DAY CENTER
  • Facility Address: 4805 BENSON AVE
    BALTIMORE, MD
    ZIP 21227
  • Facility Phone: 410 735-5433
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: ANGELICA MOONEY
  • NPI Number: 1588862627
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2282566
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name LIFE INC ADULT MEDICAL DAY CENTER
Street 4805 BENSON AVE
City BALTIMORE
State MD
ZIP 21227
Phone 410 735-5433
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2025
Certificate Expiration Date 5/22/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director ANGELICA MOONEY

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