1205104882 NPI number — REST ASSURED SLEEP DISORDERS, 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 1205104882 NPI number — REST ASSURED SLEEP DISORDERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REST ASSURED SLEEP DISORDERS, 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:
6
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:
1205104882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 CHINQUAPIN ROUND RD
Provider Second Line Business Mailing Address:
SUITE 2L
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-4006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-897-8445
Provider Business Mailing Address Fax Number:
866-429-2689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8700 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
LANDOVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20785-4831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-897-8445
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
AKINNAGBE
Authorized Official First Name:
JUMOKE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-897-8445

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: 406384801 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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