Provider Demographics
NPI:1003963273
Name:AMERICAN DIAGNSOTIC LAB., INC
Entity Type:Organization
Organization Name:AMERICAN DIAGNSOTIC LAB., INC
Other - Org Name:FEEL WELL REHAB CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEDEIROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-984-5200
Mailing Address - Street 1:144 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4046
Mailing Address - Country:US
Mailing Address - Phone:508-984-5200
Mailing Address - Fax:508-996-8614
Practice Address - Street 1:144 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4046
Practice Address - Country:US
Practice Address - Phone:508-984-5200
Practice Address - Fax:508-996-8614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34550225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA61439OtherHARVARD PILGRIM
MA34994OtherNEIGHBORHOOD HEALTH