Organization
LIBERTY MOBILE LABS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD JOSEPH HANSEN AMCA-PCT 4709 (OWNER)
(630) 880-9517
Entity
Organization
Contact information
Practice address
541 SPRUCE RD, BOLINGBROOK, IL 60440-2504
(630) 880-9454
(630) 596-1404
Mailing address
541 SPRUCE RD, BOLINGBROOK, IL 60440-2504
(630) 880-9517
(630) 596-1404
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
07/20/2018
Last updated
11/23/2019
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