Provider Demographics
NPI:1902138829
Name:FRIENDS TESTING FACILITY INC
Entity Type:Organization
Organization Name:FRIENDS TESTING FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-392-0969
Mailing Address - Street 1:601 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3977
Mailing Address - Country:US
Mailing Address - Phone:305-392-0969
Mailing Address - Fax:305-456-2097
Practice Address - Street 1:601 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3977
Practice Address - Country:US
Practice Address - Phone:305-392-0969
Practice Address - Fax:305-456-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8640261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC8640OtherAHCA HCC UNIT