Provider Demographics
NPI:1144285685
Name:BRIGHTON CENTER FOR SLEEP DISORDERS LLC
Entity type:Organization
Organization Name:BRIGHTON CENTER FOR SLEEP DISORDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-500-2114
Mailing Address - Street 1:112 MELLON ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3536
Mailing Address - Country:US
Mailing Address - Phone:304-254-9090
Mailing Address - Fax:304-254-8802
Practice Address - Street 1:36 S 18TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2412
Practice Address - Country:US
Practice Address - Phone:303-654-9748
Practice Address - Fax:303-654-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63239833Medicaid
COC802163Medicare PIN