Provider Demographics
NPI:1174096598
Name:MOBILE LABS AT YOUR SERVICE LLC
Entity type:Organization
Organization Name:MOBILE LABS AT YOUR SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-487-9940
Mailing Address - Street 1:601 WOODARD AVE # 601
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5245
Mailing Address - Country:US
Mailing Address - Phone:817-526-1120
Mailing Address - Fax:817-774-2075
Practice Address - Street 1:601 WOODARD AVE # 601
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5245
Practice Address - Country:US
Practice Address - Phone:817-526-1120
Practice Address - Fax:817-774-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700352275Medicaid