EDENTON RETIREMENT COMMUNITY
NPI 1962484857
Assisted Living Facility in Frederick, MD
- Organization
- Assisted Living Facility
- CLIA Number: 21D2060415
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 06-10-2027
About EDENTON RETIREMENT COMMUNITY
This page provides the complete NPI Profile along with additional information for Edenton Retirement Community, a provider established in Frederick, Maryland operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1962484857 assigned on November 2005. The practitioner's primary taxonomy code is 310400000X with license number 10AL011 (MD). The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as Edenton Retirement Community. The authorized official of this NPI record is Ms. Raeann E. Butler (Administrator)
- NPI
- 1962484857 Verify this NPI
- Provider Legal Name
- CLOSUP I, INC.
- Other Organization Name
- EDENTON RETIREMENT COMMUNITY
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 5800 GENESIS LN FREDERICK, MD 21703
- Location Phone
- (301) 694-3100
- Location Fax
- (301) 694-0745
- Mailing Address
- 5800 GENESIS LN FREDERICK, MD 21703
- Mailing Phone
- (301) 694-3100
- Mailing Fax
- (301) 694-0745
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-16-2005
- Last Update Date
- 08-22-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 10AL011
- License State
- MD
- Taxonomy Description
- A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | 10AL021 (MD) |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 21D2060415
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- June 11, 2025
- Certificate Expiration Date
- June 10, 2027
- Laboratory Director
- TIARA Y. WEEDON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Edenton Retirement Community to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1962484857, enumerated as an "organization" on November 16, 2005.
The provider is located at 5800 GENESIS LN FREDERICK, MD 21703 and the phone number is (301) 694-3100.
Assisted Living Facility with taxonomy code 310400000X.
