MEDICARE: FIRST LOVE LABORATORY

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1215521562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST LOVE LABORATORY

Provider Business Mailing Address
First Line	:	4933 MONTICELLO BLVD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2847
Country	:	US
Telephone Number	:	216-224-4113
Fax Number	:

Provider Business Practice Location Address
First Line	:	4933 MONTICELLO BLVD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2847
Country	:	US
Telephone Number	:	216-224-4113
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TONIKA JOHNSON
Credential	:	LPN
Telephone Number	:	216-224-4113

Provider Enumeration Date	:	02/26/2021
Last Update Date	:	04/15/2021

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Directions to “FIRST LOVE LABORATORY ” Practice Location

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