Provider Demographics
NPI:1457315053
Name:LIVONIA SLEEP CENTER LLC
Entity Type:Organization
Organization Name:LIVONIA SLEEP CENTER LLC
Other - Org Name:LIMITED LIABILITY CORPORATION LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-755-5522
Mailing Address - Street 1:3055 KETTERING BLVD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1900
Mailing Address - Country:US
Mailing Address - Phone:586-948-3803
Mailing Address - Fax:586-948-3804
Practice Address - Street 1:17880 FARMINGTON RD
Practice Address - Street 2:BLDG B
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3104
Practice Address - Country:US
Practice Address - Phone:248-465-1848
Practice Address - Fax:248-380-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H22686OtherBLUE CROSS AND BLUE SHIEL
MI0P2730Medicare ID - Type Unspecified