Provider Demographics
NPI:1235387176
Name:BLACK LAB, INC.
Entity Type:Organization
Organization Name:BLACK LAB, INC.
Other - Org Name:LIVING ASSISTANCE, VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NAPOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-787-3033
Mailing Address - Street 1:PO BOX 2337
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-2337
Mailing Address - Country:US
Mailing Address - Phone:727-787-3033
Mailing Address - Fax:727-789-5085
Practice Address - Street 1:922 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4223
Practice Address - Country:US
Practice Address - Phone:727-787-3033
Practice Address - Fax:787-789-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211281251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health