Healthcare Provider Details

I. General information

NPI: 1376202689
Provider Name (Legal Business Name): CARE4ALL LAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 PAYNE AVE STE B2
SAINT PAUL MN
55130-4280
US

IV. Provider business mailing address

925 PAYNE AVE STE B2
SAINT PAUL MN
55130-4280
US

V. Phone/Fax

Practice location:
  • Phone: 651-615-2344
  • Fax:
Mailing address:
  • Phone: 651-615-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: COA FERREN MURRELL
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 651-615-2344