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General NPI Number Information
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NPI Number | 1447422167
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Entity Type | Organization
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Legal Business Name | MOBILE LABORATORY HEALTH SERVICES
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 110 N. THIRD AVE.
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City | SANDPOINT
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State | ID
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Zip | 83864
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Country | US
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Telephone | 208-946-6746
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Fax | 188-832-0983
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Provider Business Mailing Address
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Address Line | 110 N. THIRD AVE.
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City | SANDPOINT
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State | ID
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Zip | 83864
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Country | US
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Telephone | 208-946-6746
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Fax | 188-832-0983
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE MICHELLE BOTTENFIELD
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Credential | CLPLB
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Telephone | 208-946-6746
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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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