Provider Demographics
NPI:1467614602
Name:LUCID SLEEP INC
Entity Type:Organization
Organization Name:LUCID SLEEP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ENEVOLDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-995-8243
Mailing Address - Street 1:8333 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3154
Mailing Address - Country:US
Mailing Address - Phone:877-995-8243
Mailing Address - Fax:877-995-8253
Practice Address - Street 1:8333 FOOTHILL BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3154
Practice Address - Country:US
Practice Address - Phone:877-995-8243
Practice Address - Fax:877-995-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05041ZMedicare PIN
TG352Medicare PIN