Organization
PROVIDENCE CLINICAL LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL JOAN EVANS B.O.R ASCP CERTIFIED (CHIEF EXECUTIVE OFFICER)
(856) 534-5367
Entity
Organization
Contact information
Practice address
317 AVA AVE, SOMERDALE, NJ 08083-1603
(856) 534-5367
(856) 435-6067
Mailing address
PO BOX 213, SOMERDALE, NJ 08083-0213
(856) 534-5367
(856) 435-6067
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
1492292
NJ
291U00000X
Clinical Medical Laboratory
Primary
1492292
NJ
Other
Enumeration date
09/01/2010
Last updated
09/07/2023
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