1912264102 NPI number — SLEEP WELLNESS INSTITUTE, INC

Table of content: (NPI 1912264102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912264102 NPI number — SLEEP WELLNESS INSTITUTE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP WELLNESS INSTITUTE, 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:
1912264102
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2356 S 102ND ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WEST ALLIS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53227-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-336-3000
Provider Business Mailing Address Fax Number:
414-336-1015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11725 N PORT WASHINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
MEQUON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53092-3485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-336-3000
Provider Business Practice Location Address Fax Number:
414-336-1015
Provider Enumeration Date:
04/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DEVINE
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
414-336-3000

Provider Taxonomy Codes

  • Taxonomy code: 173F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32890000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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