Provider Demographics
NPI:1164736005
Name:VILLAGE SLEEP CENTER INC
Entity Type:Organization
Organization Name:VILLAGE SLEEP CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRCEA
Authorized Official - Middle Name:T
Authorized Official - Last Name:IACOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-520-8547
Mailing Address - Street 1:1100 LAKE ST STE LL40
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE ST STE LL40
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1066
Practice Address - Country:US
Practice Address - Phone:312-520-8547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113093261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic