Provider Demographics
NPI:1326872326
Name:DIVINE LAB AND FINGERPRINTING , LLC
Entity type:Organization
Organization Name:DIVINE LAB AND FINGERPRINTING , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FELECIA
Authorized Official - Middle Name:KERRY-ANN
Authorized Official - Last Name:WOOLCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-998-0880
Mailing Address - Street 1:6067 HOLLYWOOD BLVD STE 325
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7891
Mailing Address - Country:US
Mailing Address - Phone:954-998-0880
Mailing Address - Fax:
Practice Address - Street 1:6067 HOLLYWOOD BLVD STE 325
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-7891
Practice Address - Country:US
Practice Address - Phone:954-998-0880
Practice Address - Fax:954-416-6818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory