Provider Demographics
NPI:1417447210
Name:HIBERNATION SLEEP MN LLC
Entity Type:Organization
Organization Name:HIBERNATION SLEEP MN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COGSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-888-4680
Mailing Address - Street 1:2278 COMO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1740
Mailing Address - Country:US
Mailing Address - Phone:651-888-4680
Mailing Address - Fax:
Practice Address - Street 1:2278 COMO AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1740
Practice Address - Country:US
Practice Address - Phone:651-888-4680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13398122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty