Provider Demographics
NPI:1295326700
Name:SOUTHLAND HOME LABS CORP.,
Entity type:Organization
Organization Name:SOUTHLAND HOME LABS CORP.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADETOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-228-2745
Mailing Address - Street 1:1313 E SIBLEY BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-2963
Mailing Address - Country:US
Mailing Address - Phone:708-228-2745
Mailing Address - Fax:708-880-0702
Practice Address - Street 1:1313 E SIBLEY BLVD STE 108
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-2963
Practice Address - Country:US
Practice Address - Phone:708-228-2745
Practice Address - Fax:708-880-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory