Provider Demographics
NPI:1619417136
Name:MELIOREM SLEEP SERVICES
Entity Type:Organization
Organization Name:MELIOREM SLEEP SERVICES
Other - Org Name:MELIOREM SLEEP CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:INNOCENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:EZENWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:755-557-4900
Mailing Address - Street 1:2115 GREEN VISTA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8516
Mailing Address - Country:US
Mailing Address - Phone:775-557-4900
Mailing Address - Fax:775-557-7240
Practice Address - Street 1:2115 GREEN VISTA DR STE 101
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8516
Practice Address - Country:US
Practice Address - Phone:775-557-4900
Practice Address - Fax:775-557-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16000207RS0012X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty