Provider Demographics
NPI:1104200088
Name:GAYLORD SLEEP HEALTHCENTERS OF CONNECTICUT LLC
Entity Type:Organization
Organization Name:GAYLORD SLEEP HEALTHCENTERS OF CONNECTICUT LLC
Other - Org Name:EASTERN SLEEP & RESPIRATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FALKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-400-0044
Mailing Address - Street 1:277 SOUTH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2731
Mailing Address - Country:US
Mailing Address - Phone:617-999-9908
Mailing Address - Fax:866-203-5459
Practice Address - Street 1:277 SOUTH ST STE 1
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2731
Practice Address - Country:US
Practice Address - Phone:617-999-9908
Practice Address - Fax:866-203-5459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONWIDE SLEEP HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-10
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008039999Medicaid
CT008039999Medicaid