Provider Demographics
NPI:1952922908
Name:OPTIMUM FAITH LAB CORP
Entity Type:Organization
Organization Name:OPTIMUM FAITH LAB CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-610-0434
Mailing Address - Street 1:1109 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-5301
Mailing Address - Country:US
Mailing Address - Phone:224-610-0434
Mailing Address - Fax:855-325-1872
Practice Address - Street 1:1109 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-5301
Practice Address - Country:US
Practice Address - Phone:224-610-0434
Practice Address - Fax:855-325-1872
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMUM FAITH LAB CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies