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General NPI Number Information
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NPI Number | 1235387176
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Entity Type | Organization
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Legal Business Name | BLACK LAB, INC.
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 922 FLORIDA AVE
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City | PALM HARBOR
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State | FL
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Zip | 34683-4223
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Country | US
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Telephone | 727-787-3033
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Fax | 787-789-5085
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Provider Business Mailing Address
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Address Line | PO BOX 2337
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City | PALM HARBOR
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State | FL
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Zip | 34682-2337
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Country | US
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Telephone | 727-787-3033
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Fax | 727-789-5085
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. BEVERLY R NAPOLI
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Credential |
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Telephone | 727-787-3033
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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 | 30211281
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License Number State | FL
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