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General NPI Number Information
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NPI Number | 1023761756
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Entity Type | Organization
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Legal Business Name | SHARON ANGELS LAB LLC
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 2200 MCLAURIN ST. STE A
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City | WAVELAND
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State | MS
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Zip | 39576
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Country | US
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Telephone | 228-344-3178
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Fax | 228-344-3179
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Provider Business Mailing Address
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Address Line | 2200 MCLAURIN ST. STE A
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City | WAVELAND
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State | MS
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Zip | 39576
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Country | US
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Telephone | 228-344-3178
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Fax | 228-344-3179
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Authorized Official
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Title or Position | OWNER
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Name | TONI THOMAS
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Credential |
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Telephone | 228-342-7437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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