1679871792 NPI number — COMPREHENSIVE SLEEP SOLUTIONS & DIAGNOSTIC CENTER, LLC

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 1679871792 NPI number — COMPREHENSIVE SLEEP SOLUTIONS & DIAGNOSTIC CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE SLEEP SOLUTIONS & DIAGNOSTIC CENTER, 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:
1679871792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 CHALFONTE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-2930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-510-9971
Provider Business Mailing Address Fax Number:
313-417-8090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27177 LAHSER RD
Provider Second Line Business Practice Location Address:
210
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-223-9747
Provider Business Practice Location Address Fax Number:
313-226-0668
Provider Enumeration Date:
03/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MADDEN
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-510-9971

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)





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