Provider Demographics
NPI:1346736071
Name:ARROWHEAD PRO SLEEP, LLC
Entity Type:Organization
Organization Name:ARROWHEAD PRO SLEEP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-680-4540
Mailing Address - Street 1:23010 N 65TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-4234
Mailing Address - Country:US
Mailing Address - Phone:928-246-0500
Mailing Address - Fax:
Practice Address - Street 1:16222 N 59TH AVE STE D170
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1708
Practice Address - Country:US
Practice Address - Phone:602-680-4564
Practice Address - Fax:602-926-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty