1124185350 NPI number — COMPREHENSIVE SLEEP SOLUTIONS, LLC

Table of content: (NPI 1124185350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124185350 NPI number — COMPREHENSIVE SLEEP SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE SLEEP SOLUTIONS, 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:
1124185350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40520
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85274-0520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-446-9010
Provider Business Mailing Address Fax Number:
480-993-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12725 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
F-102
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85323-9520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-935-2226
Provider Business Practice Location Address Fax Number:
623-935-5027
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
480-446-9010

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 118104 . This is a "MEDICARE B PROVIDER #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 209630 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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