Provider Demographics
NPI:1639487754
Name:WOODLAWN MEADOWS RETIREMENT VILLAGE, LLC
Entity Type:Organization
Organization Name:WOODLAWN MEADOWS RETIREMENT VILLAGE, LLC
Other - Org Name:WOODLAWN MEADOWS RETIREMENT VILLAGE - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-948-4921
Mailing Address - Street 1:1821 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1367
Mailing Address - Country:US
Mailing Address - Phone:269-948-4921
Mailing Address - Fax:
Practice Address - Street 1:1821 N EAST ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1367
Practice Address - Country:US
Practice Address - Phone:269-948-4921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D1046098291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory