Provider Demographics
NPI:1154730463
Name:RECOVERY LABORATORY, LLC
Entity type:Organization
Organization Name:RECOVERY LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-865-5664
Mailing Address - Street 1:5875 FLEUR DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-2883
Mailing Address - Country:US
Mailing Address - Phone:515-298-7209
Mailing Address - Fax:515-864-0408
Practice Address - Street 1:608 NORTH ST
Practice Address - Street 2:
Practice Address - City:ADAIR
Practice Address - State:IA
Practice Address - Zip Code:50002-1126
Practice Address - Country:US
Practice Address - Phone:515-298-7209
Practice Address - Fax:515-864-0408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. GREGORY CENTERS HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16D2016890291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory