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General NPI Number Information
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NPI Number | 1154855112
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Entity Type | Organization
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Legal Business Name | TRUE LABORATORIES LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 08/11/2018
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Provider Practice Location Address
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Address Line | 5320 159TH ST STE 505
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City | OAK FOREST
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State | IL
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Zip | 60452
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Country | US
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Telephone | 708-620-5790
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Fax | 708-650-5215
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Provider Business Mailing Address
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Address Line | 5320 159TH ST STE 505
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City | OAK FOREST
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State | IL
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Zip | 60452-3335
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Country | US
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Telephone | 708-620-5790
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Fax | 708-650-5215
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. CAROLINE MANZANO-MANGUERRA
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Credential | RN
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Telephone | 708-262-8273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 14D2128420
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License Number State | IL
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