Provider Demographics
NPI:1114795036
Name:GREENAWAY'S LAB ESSENTIAL TESTING & SCREENING, LLC
Entity Type:Organization
Organization Name:GREENAWAY'S LAB ESSENTIAL TESTING & SCREENING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:346-379-6917
Mailing Address - Street 1:13700 VETERANS MEMORIAL DR STE 240B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1035
Mailing Address - Country:US
Mailing Address - Phone:346-379-6917
Mailing Address - Fax:
Practice Address - Street 1:13700 VETERANS MEMORIAL DR STE 240B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1035
Practice Address - Country:US
Practice Address - Phone:346-379-6917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service