Healthcare Provider Details

I. General information

NPI: 1023721750
Provider Name (Legal Business Name): PHLEBLAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 RICHMOND RD
RICHMOND HTS OH
44143-2792
US

IV. Provider business mailing address

1536 SAINT CLAIR AVE NE
CLEVELAND OH
44114-2004
US

V. Phone/Fax

Practice location:
  • Phone: 216-832-6764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. RENEE DENISE BLACKMON
Title or Position: CEO
Credential: CEO
Phone: 216-832-6764