1811951221 NPI number — SLEEPCARDIA LLC

Table of content: TIARA CARTER (NPI 1689274706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811951221 NPI number — SLEEPCARDIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEPCARDIA 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:
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:
1811951221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18223 E 10 MILE RD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48066-5821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-225-8500
Provider Business Mailing Address Fax Number:
888-977-3829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18223 E 10 MILE RD
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48066-5821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-818-0205
Provider Business Practice Location Address Fax Number:
586-948-3804
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NASUTI
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
586-250-5330

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  B0964R , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 469024110 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7696683 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P08740 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0E01605 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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