1073613923 NPI number — SLEEP SERVICES OF AMERICA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073613923 NPI number — SLEEP SERVICES OF AMERICA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP SERVICES OF AMERICA, 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:
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:
1073613923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 WOODRUFF RD
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29607-3495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-527-5970
Provider Business Mailing Address Fax Number:
864-527-5971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 AIRPORT PARK RD
Provider Second Line Business Practice Location Address:
SUITE 119
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-760-6990
Provider Business Practice Location Address Fax Number:
410-760-9497
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MELLOTT
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
864-527-5970

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  08228826 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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