Provider Demographics
NPI:1154855112
Name:TRUE LABORATORIES LLC
Entity Type:Organization
Organization Name:TRUE LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZANO-MANGUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-262-8273
Mailing Address - Street 1:5320 159TH ST STE 505
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3335
Mailing Address - Country:US
Mailing Address - Phone:708-620-5790
Mailing Address - Fax:708-650-5215
Practice Address - Street 1:5320 159TH ST STE 505
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452
Practice Address - Country:US
Practice Address - Phone:708-620-5790
Practice Address - Fax:708-650-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D2128420291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory