Provider Demographics
NPI:1144415134
Name:SLEEPCARE SOURCE, LLC
Entity Type:Organization
Organization Name:SLEEPCARE SOURCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORPENING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-482-2727
Mailing Address - Street 1:4629 WHITNEY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4119
Mailing Address - Country:US
Mailing Address - Phone:916-482-2727
Mailing Address - Fax:916-488-2727
Practice Address - Street 1:4629 WHITNEY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4119
Practice Address - Country:US
Practice Address - Phone:916-482-2727
Practice Address - Fax:916-488-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6002160001Medicare NSC