Provider Demographics
NPI:1831439876
Name:HIGHER GROUND LABORATORY LLC
Entity type:Organization
Organization Name:HIGHER GROUND LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-440-7009
Mailing Address - Street 1:17626 DEER FLAT RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-9779
Mailing Address - Country:US
Mailing Address - Phone:208-455-5644
Mailing Address - Fax:208-620-2376
Practice Address - Street 1:17626 DEER FLAT RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-9779
Practice Address - Country:US
Practice Address - Phone:208-455-5644
Practice Address - Fax:208-620-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-4116291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory