Provider Demographics
NPI:1346989704
Name:CHROME RESIDENTIAL, LLC
Entity Type:Organization
Organization Name:CHROME RESIDENTIAL, LLC
Other - Org Name:CHROME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENCHLOUCH HARAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-949-6350
Mailing Address - Street 1:14030 DAVANA TER
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4244
Mailing Address - Country:US
Mailing Address - Phone:323-949-6350
Mailing Address - Fax:
Practice Address - Street 1:14030 DAVANA TER
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-4244
Practice Address - Country:US
Practice Address - Phone:323-949-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D2271473OtherCLIA
CACB406422OtherMEDICARE
CACLR-90008102OtherCDPH - CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE