Provider Demographics
NPI:1699527804
Name:DREAM LAB DRUG AND ALCOHOL TESTING
Entity type:Organization
Organization Name:DREAM LAB DRUG AND ALCOHOL TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHEKENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTY BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-537-3262
Mailing Address - Street 1:P.O BOX 277
Mailing Address - Street 2:138 E. PEELER AVE SUIT-277
Mailing Address - City:SHAW
Mailing Address - State:MS
Mailing Address - Zip Code:38773
Mailing Address - Country:US
Mailing Address - Phone:833-537-3262
Mailing Address - Fax:818-855-7826
Practice Address - Street 1:138 E. PEELER
Practice Address - Street 2:AVE SUIT-277
Practice Address - City:SHAW
Practice Address - State:MS
Practice Address - Zip Code:38773
Practice Address - Country:US
Practice Address - Phone:833-537-3262
Practice Address - Fax:818-855-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory