Provider Demographics
NPI:1376912642
Name:ORANGE GROVE LABS LLC
Entity Type:Organization
Organization Name:ORANGE GROVE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVALEIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-567-0063
Mailing Address - Street 1:1325 S KILLIAN DR
Mailing Address - Street 2:UNIT 3A
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1965
Mailing Address - Country:US
Mailing Address - Phone:561-567-0063
Mailing Address - Fax:
Practice Address - Street 1:1325 S KILLIAN DR
Practice Address - Street 2:UNIT 3A
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-1965
Practice Address - Country:US
Practice Address - Phone:561-567-0063
Practice Address - Fax:561-847-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory