Provider Demographics
NPI:1346394293
Name:REM MEDICAL WEST PHOENIX LLC
Entity Type:Organization
Organization Name:REM MEDICAL WEST PHOENIX LLC
Other - Org Name:SLEEP HEALTHCENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-783-1441
Mailing Address - Street 1:187 BALLARDVALE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-1082
Mailing Address - Country:US
Mailing Address - Phone:978-774-7243
Mailing Address - Fax:978-774-7421
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:SUITE 305
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-271-9323
Practice Address - Fax:623-321-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ174198Medicaid
AZ174198Medicaid