Provider Demographics
NPI:1457841421
Name:COMPLETE SLEEP LAB INC
Entity Type:Organization
Organization Name:COMPLETE SLEEP LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-584-5963
Mailing Address - Street 1:314 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7128
Mailing Address - Country:US
Mailing Address - Phone:302-584-5963
Mailing Address - Fax:302-366-8905
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7128
Practice Address - Country:US
Practice Address - Phone:302-584-5963
Practice Address - Fax:302-366-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center