Provider Demographics
NPI:1669087003
Name:ANGEL'S HOME LAB SERVICES LLC
Entity type:Organization
Organization Name:ANGEL'S HOME LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NCPT
Authorized Official - Phone:773-817-0477
Mailing Address - Street 1:400 LILLIAN LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2518
Mailing Address - Country:US
Mailing Address - Phone:224-242-9630
Mailing Address - Fax:224-215-8838
Practice Address - Street 1:400 LILLIAN LN
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2518
Practice Address - Country:US
Practice Address - Phone:224-242-9630
Practice Address - Fax:224-215-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory