Provider Demographics
NPI:1316138035
Name:LAVA SUPPLY, INC
Entity type:Organization
Organization Name:LAVA SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-329-1238
Mailing Address - Street 1:4008 AMALFI DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5633
Mailing Address - Country:US
Mailing Address - Phone:847-329-1238
Mailing Address - Fax:847-329-1255
Practice Address - Street 1:303 E DUNDEE RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3107
Practice Address - Country:US
Practice Address - Phone:847-329-1238
Practice Address - Fax:847-329-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies