Provider Demographics
NPI:1265447718
Name:SLEEP RESOURCE CONSULTING SERVICE LLC
Entity Type:Organization
Organization Name:SLEEP RESOURCE CONSULTING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEVERKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-855-7570
Mailing Address - Street 1:PO BOX 3267
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-3267
Mailing Address - Country:US
Mailing Address - Phone:928-855-7570
Mailing Address - Fax:928-855-7574
Practice Address - Street 1:1695 MESQUITE AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5684
Practice Address - Country:US
Practice Address - Phone:928-855-7570
Practice Address - Fax:928-855-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01398174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ881525Medicaid
AZZ71482Medicare PIN
AZ4577170001Medicare NSC