Organization
LIFE-LIKE LABORATORY LLC
Active
Other names
Life-Like Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL FANCHER (OWNER)
(972) 620-0203
Entity
Organization
Contact information
Practice address
1548 VALWOOD PKWY STE 108, CARROLLTON, TX 75006-6859
(972) 620-0203
(972) 620-0204
Mailing address
1548 VALWOOD PKWY STE 108, CARROLLTON, TX 75006-6859
(972) 620-0203
(972) 620-0204
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
507603
BCBS
TX
Enumeration date
03/15/2006
Last updated
06/09/2022
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