Provider Demographics
NPI:1770267668
Name:PRETORIAN LABS, LLC
Entity type:Organization
Organization Name:PRETORIAN LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-659-1980
Mailing Address - Street 1:7650 HUB PKWY
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5707
Mailing Address - Country:US
Mailing Address - Phone:440-659-1980
Mailing Address - Fax:440-659-6059
Practice Address - Street 1:1853 HICKS RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1252
Practice Address - Country:US
Practice Address - Phone:440-659-1980
Practice Address - Fax:440-650-6059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRETORIAN LABS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-12
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory