Provider Demographics
NPI:1346401270
Name:BSAM HOLDINGS INC
Entity Type:Organization
Organization Name:BSAM HOLDINGS INC
Other - Org Name:SLEEP DISORDER SOLUTIONS PORT ST LUCIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHABIR-HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-323-2660
Mailing Address - Street 1:525 NW LAKE WHITNEY PL
Mailing Address - Street 2:BLDG P - STE 103
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1605
Mailing Address - Country:US
Mailing Address - Phone:772-323-2660
Mailing Address - Fax:772-323-2666
Practice Address - Street 1:525 NW LAKE WHITNEY PL
Practice Address - Street 2:BLDG P - STE 103
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1605
Practice Address - Country:US
Practice Address - Phone:772-323-2660
Practice Address - Fax:772-323-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies