Provider Demographics
NPI:1306370283
Name:SLEEP EZ FAMILY AND SLEEP HEALTH LLC
Entity Type:Organization
Organization Name:SLEEP EZ FAMILY AND SLEEP HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-221-2535
Mailing Address - Street 1:13241 BARTRAM PARK BLVD UNIT 2009
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5223
Mailing Address - Country:US
Mailing Address - Phone:833-417-5337
Mailing Address - Fax:904-930-4222
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 2009
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5223
Practice Address - Country:US
Practice Address - Phone:833-417-5337
Practice Address - Fax:904-930-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJK300AOtherMEDICARE