Provider Demographics
NPI:1053054858
Name:GOLDEN LABS LLC
Entity Type:Organization
Organization Name:GOLDEN LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-860-1081
Mailing Address - Street 1:4001 W DEVON AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4539
Mailing Address - Country:US
Mailing Address - Phone:847-860-1081
Mailing Address - Fax:
Practice Address - Street 1:4001 W DEVON AVE STE 406
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4539
Practice Address - Country:US
Practice Address - Phone:847-860-1081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory