Provider Demographics
NPI:1649076381
Name:YOUR PRIVATE LABS LLC
Entity type:Organization
Organization Name:YOUR PRIVATE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-500-7292
Mailing Address - Street 1:1905 S WOLF RD
Mailing Address - Street 2:UNIT 302
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162
Mailing Address - Country:US
Mailing Address - Phone:224-500-7292
Mailing Address - Fax:
Practice Address - Street 1:1 MID AMERICA PLZ UNIT 5004
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4450
Practice Address - Country:US
Practice Address - Phone:224-500-7292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty