MEDICARE: SECURE LABS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1093470171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURE LABS LLC

Provider Business Mailing Address
First Line	:	1836 STRAHLE STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2323
Country	:	US
Telephone Number	:	215-796-7950
Fax Number	:

Provider Business Practice Location Address
First Line	:	1836 STRAHLE STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2323
Country	:	US
Telephone Number	:	215-796-7950
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CECILIAH MUIRURI SCHWARTZ
Credential	:	LPN
Telephone Number	:	215-796-7950

Provider Enumeration Date	:	11/03/2021
Last Update Date	:	11/08/2021

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