Provider Demographics
NPI:1720419658
Name:REAL LIFE LAB, LLC
Entity Type:Organization
Organization Name:REAL LIFE LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-265-5951
Mailing Address - Street 1:258 SE 6TH AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5259
Mailing Address - Country:US
Mailing Address - Phone:561-265-5951
Mailing Address - Fax:
Practice Address - Street 1:258 SE 6TH AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5259
Practice Address - Country:US
Practice Address - Phone:561-265-5951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REAL LIFE RECOVERY DELRAY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory