Provider Demographics
NPI:1396899811
Name:COMMUNITY LABORATORY, INC.
Entity type:Organization
Organization Name:COMMUNITY LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KLARA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:SARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-292-0186
Mailing Address - Street 1:24331 VAN BORN RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1225
Mailing Address - Country:US
Mailing Address - Phone:313-292-0186
Mailing Address - Fax:313-292-0289
Practice Address - Street 1:24331 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1225
Practice Address - Country:US
Practice Address - Phone:313-292-0186
Practice Address - Fax:313-292-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H21522OtherBLUE CROSS BLUE SHEILD
MI1740644Medicaid
MI1740644Medicaid