Organization
LONG TERM CARE LABORATORY, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAM SHIMI (ADMINSTRATOR)
(630) 422-7802
Entity
Organization
Contact information
Practice address
2458 ELMHURST RD, ELK GROVE VILLAGE, IL 60007-6311
(630) 422-7800
(630) 422-1360
Mailing address
2458 ELMHURST RD, ELK GROVE VILLAGE, IL 60007-6311
(630) 422-7800
(630) 422-1360
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D2026754
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D2026754
CLIA
IL
Enumeration date
12/06/2011
Last updated
08/08/2013
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