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General NPI Number Information
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NPI Number | 1669087003
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Entity Type | Organization
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Legal Business Name | ANGEL'S HOME LAB SERVICES LLC
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Dates
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Enumeration Date | 09/12/2020
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Last Update Date | 09/12/2020
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Provider Practice Location Address
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Address Line | 400 LILLIAN LN
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City | DES PLAINES
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State | IL
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Zip | 60016-2518
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Country | US
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Telephone | 224-242-9630
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Fax | 224-215-8838
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Provider Business Mailing Address
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Address Line | 400 LILLIAN LN
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City | DES PLAINES
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State | IL
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Zip | 60016-2518
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Country | US
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Telephone | 224-242-9630
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Fax | 224-215-8838
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | LAURA DOMINGUEZ
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Credential | N.C.P.T.
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Telephone | 773-817-0477
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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 |
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License Number State |
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