Provider Demographics
NPI:1467914721
Name:365 HEALTH DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:365 HEALTH DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAGNANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-563-6000
Mailing Address - Street 1:22260 GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2208
Mailing Address - Country:US
Mailing Address - Phone:313-563-6000
Mailing Address - Fax:313-563-6001
Practice Address - Street 1:22260 GARRISON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2208
Practice Address - Country:US
Practice Address - Phone:313-563-6000
Practice Address - Fax:313-563-6001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:365 HEALTH CARE GROUP PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory