Provider Demographics
NPI:1578160545
Name:COLORADO SLEEP WELLNESS LLC
Entity Type:Organization
Organization Name:COLORADO SLEEP WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHKLOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-433-9777
Mailing Address - Street 1:161 N PARK SQ
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2530
Mailing Address - Country:US
Mailing Address - Phone:970-433-9700
Mailing Address - Fax:
Practice Address - Street 1:161 N PARK SQ
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2530
Practice Address - Country:US
Practice Address - Phone:970-433-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty