Provider Demographics
NPI:1164896130
Name:SOMNIUM DME LLC
Entity Type:Organization
Organization Name:SOMNIUM DME LLC
Other - Org Name:SOMNIUM DME SOUTH BEND
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHADEVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-498-4259
Mailing Address - Street 1:4455 EDISON LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1442
Mailing Address - Country:US
Mailing Address - Phone:574-231-6895
Mailing Address - Fax:574-231-6852
Practice Address - Street 1:4455 EDISON LAKES PKWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1442
Practice Address - Country:US
Practice Address - Phone:574-231-6895
Practice Address - Fax:574-231-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies