Provider Demographics
NPI:1366068454
Name:GIVE LEGACY, INC.
Entity type:Organization
Organization Name:GIVE LEGACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:KTEILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-416-6024
Mailing Address - Street 1:19 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 GARDEN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3622
Practice Address - Country:US
Practice Address - Phone:617-416-6024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory