Provider Demographics
NPI:1154120830
Name:CHOSEN LAB SERVICES LLC
Entity type:Organization
Organization Name:CHOSEN LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:504-654-0592
Mailing Address - Street 1:116 KIMBERLY ST
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-5130
Mailing Address - Country:US
Mailing Address - Phone:504-944-1070
Mailing Address - Fax:985-332-2022
Practice Address - Street 1:4266 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-6421
Practice Address - Country:US
Practice Address - Phone:504-944-1070
Practice Address - Fax:504-654-0592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service