Provider Demographics
NPI:1760965719
Name:VALLEYLAB
Entity Type:Organization
Organization Name:VALLEYLAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-949-9588
Mailing Address - Street 1:4460 S HIGHLAND DR STE 310
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3562
Mailing Address - Country:US
Mailing Address - Phone:801-694-5208
Mailing Address - Fax:
Practice Address - Street 1:4460 S HIGHLAND DR STE 110
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3550
Practice Address - Country:US
Practice Address - Phone:801-694-5208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY MENTAL HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-14
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory