Provider Demographics
NPI:1629131511
Name:HOME LAB SERVICES
Entity Type:Organization
Organization Name:HOME LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VLADYSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:BEZRUCHKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1415-299-2225
Mailing Address - Street 1:1554 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3417
Mailing Address - Country:US
Mailing Address - Phone:141-529-9222
Mailing Address - Fax:415-931-0905
Practice Address - Street 1:2205 POST ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3427
Practice Address - Country:US
Practice Address - Phone:415-299-2225
Practice Address - Fax:415-931-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA394809OtherBUSINESS CERTIFICATE #