Provider Demographics
NPI:1700194024
Name:ETHOS HOLDING CORP.
Entity Type:Organization
Organization Name:ETHOS HOLDING CORP.
Other - Org Name:ETHOS LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-616-2893
Mailing Address - Street 1:3978 MACK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5574
Mailing Address - Country:US
Mailing Address - Phone:513-314-3700
Mailing Address - Fax:513-672-0100
Practice Address - Street 1:3978 MACK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5574
Practice Address - Country:US
Practice Address - Phone:513-314-3700
Practice Address - Fax:513-672-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D2012974291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory