Provider Demographics
NPI:1114676160
Name:OPULENT LUXURY LABORATORY
Entity Type:Organization
Organization Name:OPULENT LUXURY LABORATORY
Other - Org Name:OPULENT LUX LAB LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:708-200-8675
Mailing Address - Street 1:930 E 162ND ST STE 1033
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2442
Mailing Address - Country:US
Mailing Address - Phone:708-200-8675
Mailing Address - Fax:708-566-2518
Practice Address - Street 1:930 E 162ND ST STE 1033
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2442
Practice Address - Country:US
Practice Address - Phone:708-200-8675
Practice Address - Fax:708-566-2518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty