Provider Demographics
NPI:1619664661
Name:LIFE IS IN THE BLOOD LLC
Entity type:Organization
Organization Name:LIFE IS IN THE BLOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-738-7440
Mailing Address - Street 1:PO BOX 15163
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-0163
Mailing Address - Country:US
Mailing Address - Phone:310-738-7440
Mailing Address - Fax:
Practice Address - Street 1:16206 S THORSON AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-4647
Practice Address - Country:US
Practice Address - Phone:310-738-7440
Practice Address - Fax:562-568-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty