Provider Demographics
NPI:1376925594
Name:BLUEGRASS SLEEP LLC
Entity Type:Organization
Organization Name:BLUEGRASS SLEEP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARNHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-625-2222
Mailing Address - Street 1:4530 BISHOP LN
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4561
Mailing Address - Country:US
Mailing Address - Phone:502-625-2222
Mailing Address - Fax:502-625-2223
Practice Address - Street 1:4530 BISHOP LN
Practice Address - Street 2:SUITE 108
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4561
Practice Address - Country:US
Practice Address - Phone:502-625-2222
Practice Address - Fax:502-625-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies