Provider Demographics
NPI:1205374410
Name:SOLACE LABORATORY
Entity Type:Organization
Organization Name:SOLACE LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWORDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-876-8290
Mailing Address - Street 1:1603 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4525
Mailing Address - Country:US
Mailing Address - Phone:740-876-8290
Mailing Address - Fax:
Practice Address - Street 1:1603 11TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4525
Practice Address - Country:US
Practice Address - Phone:740-876-8290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D2098367291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory