21D2297103 CLIA NUMBER - WEST BALTIMORE PACE COMMUNITY COALITION

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CLIA Code: 21D2297103
Facility Name: WEST BALTIMORE PACE COMMUNITY COALITION
Facility Address: 3201 A TIOGA PARKWAY
BALTIMORE, MD
ZIP 21215
Facility Phone: 230 940-9561
Facility Type: Practitioner Other
Facility Type: Waiver
Lab Director: NAN YAW ADU-SARKODIE
NPI Number: 1023870284
Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

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CLIA Record

Field Name	Field Value
CLIA Number	21D2297103
LAB Type	Practitioner Other
Facility Name	WEST BALTIMORE PACE COMMUNITY COALITION
Street	3201 A TIOGA PARKWAY
City	BALTIMORE
State	MD
ZIP	21215
Phone	230 940-9561
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	1/10/2024
Certificate Expiration Date	1/9/2026
Facility Type	Practitioner Other
Lab Director	NAN YAW ADU-SARKODIE

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