Provider Demographics
NPI:1134125800
Name:SLEEPWELL LABORATORIES, INC
Entity Type:Organization
Organization Name:SLEEPWELL LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-561-8471
Mailing Address - Street 1:17555 VENTURA BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3836
Mailing Address - Country:US
Mailing Address - Phone:818-933-5269
Mailing Address - Fax:818-933-5274
Practice Address - Street 1:902 W GROVE AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4930
Practice Address - Country:US
Practice Address - Phone:480-844-5902
Practice Address - Fax:480-844-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic