Provider Demographics
NPI:1578921466
Name:ARROWHEAD PRO SLEEP LLC
Entity Type:Organization
Organization Name:ARROWHEAD PRO SLEEP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KOWALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-695-2471
Mailing Address - Street 1:16222 N 59TH AVE
Mailing Address - Street 2:D170
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1701
Mailing Address - Country:US
Mailing Address - Phone:602-680-4540
Mailing Address - Fax:602-926-2445
Practice Address - Street 1:16222 N 59TH AVE
Practice Address - Street 2:D170
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1701
Practice Address - Country:US
Practice Address - Phone:602-680-4540
Practice Address - Fax:602-926-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC57813Medicare UPIN