Healthcare Provider Details

I. General information

NPI: 1194303974
Provider Name (Legal Business Name): ALPHA LAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WASHINGTON ST STE 346
CANTON MA
02021-4006
US

IV. Provider business mailing address

95 WASHINGTON ST STE 346
CANTON MA
02021-4006
US

V. Phone/Fax

Practice location:
  • Phone: 781-473-0314
  • Fax: 781-473-0314
Mailing address:
  • Phone: 781-473-0314
  • Fax: 781-473-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN FLEURIME
Title or Position: FOUNDER/ CEO
Credential:
Phone: 781-473-0314