Provider Demographics
NPI:1043238082
Name:LUCID SLEEP INC
Entity Type:Organization
Organization Name:LUCID SLEEP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ENEVOLDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RSPGT
Authorized Official - Phone:877-995-8243
Mailing Address - Street 1:8333 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:877-995-8243
Mailing Address - Fax:877-995-8253
Practice Address - Street 1:8333 FOOTHILL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:877-995-8243
Practice Address - Fax:877-995-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2558471261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG352Medicare ID - Type Unspecified