1609880608 NPI number — SLEEP NETWORK OF ILLINOIS INC

Table of content: (NPI 1609880608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609880608 NPI number — SLEEP NETWORK OF ILLINOIS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP NETWORK OF ILLINOIS INC
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:
REGIONAL CENTER FOR SLEEP MEDICINE
Provider Other Organization Name Type Code:
3
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:
1609880608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3450 W CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43606-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-535-9282
Provider Business Mailing Address Fax Number:
419-535-9443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9642 S PULASKI RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-3391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-425-3330
Provider Business Practice Location Address Fax Number:
419-535-9443
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DRAGER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
SECRETARY TREASURER
Authorized Official Telephone Number:
419-535-9282

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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