Organization
LIBERTY HOUSE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT UNDERWOOD (MANAGER)
(954) 523-1167
Entity
Organization
Contact information
Practice address
504 SE 22ND ST, FORT LAUDERDALE, FL 33316-3472
(954) 523-1167
Mailing address
1421 NW 48TH DR, BOCA RATON, FL 33431-3335
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
10D207494
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D207494
CLIA
FL
Enumeration date
04/01/2014
Last updated
04/01/2014
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