Provider Demographics
NPI:1891478376
Name:ESSENTIAL HEALTH LABS LLC
Entity Type:Organization
Organization Name:ESSENTIAL HEALTH LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-431-1455
Mailing Address - Street 1:729 THIMBLE SHOALS BLVD UNIT D
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4217
Mailing Address - Country:US
Mailing Address - Phone:757-528-6099
Mailing Address - Fax:540-772-9157
Practice Address - Street 1:729 THIMBLE SHOALS BLVD UNIT D
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4217
Practice Address - Country:US
Practice Address - Phone:757-528-6099
Practice Address - Fax:540-772-9157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty