Provider Demographics
NPI:1487867974
Name:CLASSIC SLEEPCAREIME, LLC
Entity Type:Organization
Organization Name:CLASSIC SLEEPCAREIME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-338-7155
Mailing Address - Street 1:30851 AGOURA RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4312
Mailing Address - Country:US
Mailing Address - Phone:818-338-7155
Mailing Address - Fax:888-249-3875
Practice Address - Street 1:30851 AGOURA RD
Practice Address - Street 2:SUITE 204
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4312
Practice Address - Country:US
Practice Address - Phone:818-338-7155
Practice Address - Fax:888-249-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5963330001Medicare NSC