Provider Demographics
NPI:1659145449
Name:LIFELABS LLC
Entity Type:Organization
Organization Name:LIFELABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MUSBAU
Authorized Official - Middle Name:
Authorized Official - Last Name:ENITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-415-3723
Mailing Address - Street 1:40 SAINT ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-3661
Mailing Address - Country:US
Mailing Address - Phone:202-415-3723
Mailing Address - Fax:
Practice Address - Street 1:40 SAINT ADAMS DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-3661
Practice Address - Country:US
Practice Address - Phone:202-415-3723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty