Healthcare Provider Details

I. General information

NPI: 1003619925
Provider Name (Legal Business Name): COMMUNITY CARE LABS & MOBILE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

IV. Provider business mailing address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

V. Phone/Fax

Practice location:
  • Phone: 240-206-1836
  • Fax:
Mailing address:
  • Phone: 240-206-1836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MISHELLE LA ROSE
Title or Position: PHLEBOTOMIST
Credential: CERTIFIED
Phone: 240-206-1836