1568258499 NPI number — THE HEALTH CO-LAB LLC

Table of content: (NPI 1568258499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568258499 NPI number — THE HEALTH CO-LAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEALTH CO-LAB LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568258499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 HARRISON ST APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02143-3618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-243-9620
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 CHASE HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03818-7208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-243-9620
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLMAN
Authorized Official First Name:
AARON
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
517-243-9620

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 247000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)