1508869173 NPI number — SLEEP HEALTH CENTERS LLC

Table of content: (NPI 1508869173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508869173 NPI number — SLEEP HEALTH CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP HEALTH CENTERS 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:
1508869173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1108 CITY PARK AVE
Provider Second Line Business Mailing Address:
FL2
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43206-3583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-384-7433
Provider Business Mailing Address Fax Number:
614-386-0278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
3RD
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-782-0784
Provider Business Practice Location Address Fax Number:
614-386-0278
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RUDY
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-499-0776

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 602592 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2315147 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3400029 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: A3593030 . This is a "OXFORD UHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 387454 . This is a "BCBS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017907 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 626134 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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