Lifebloom Labs LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LIFEBLOOM LABS LLC

Practice address

710 N Broad St Ste 13
Mooresville, NC 28115-9585

Phone

(704) 665-8319

NPI assigned

Oct 17, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Toneka Watson

Title

Owner

Phone

(704) 665-8319

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1275315004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3622",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283593622",
            "telephone_number": "704-665-8319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N BROAD ST STE 13",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281159585",
            "telephone_number": "704-665-8319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBLOOM LABS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-17",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "TONEKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-665-8319"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roy Sheldon Lewis, MD
• Tamara Saraina Kayleigh Lewis, LCMHCA
• LHCG L, LLC
• Jomalie N Liborio Santos
• Chong Lieu, M.D
• Lifeworks on Lake Norman
• Elisabeth Lincoln, PT
• Lindsey Atiyeh DDS PLLC 1
• Kristie Lynn Linkowski, OTR
• Jennifer Jeanne Liotino

• Clinical Medical Laboratory in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Clinical Medical Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.