Provider Demographics
NPI:1417056094
Name:SLEEP HEALTH & WELLNESS NW-HILLSBORO
Entity Type:Organization
Organization Name:SLEEP HEALTH & WELLNESS NW-HILLSBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACCIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-355-3737
Mailing Address - Street 1:2460 NE GRIFFIN OAKS ST
Mailing Address - Street 2:SUITE D 1000
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-2672
Mailing Address - Country:US
Mailing Address - Phone:503-352-0700
Mailing Address - Fax:503-352-0705
Practice Address - Street 1:2460 NE GRIFFIN OAKS ST
Practice Address - Street 2:SUITE D 1000
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:98660
Practice Address - Country:US
Practice Address - Phone:503-352-0700
Practice Address - Fax:503-352-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR006418261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5447620001Medicare NSC