Provider Demographics
NPI:1629638101
Name:CLOUD NINE SEDATIONS
Entity Type:Organization
Organization Name:CLOUD NINE SEDATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RABE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:801-540-0115
Mailing Address - Street 1:PO BOX 150721
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0721
Mailing Address - Country:US
Mailing Address - Phone:801-876-0033
Mailing Address - Fax:
Practice Address - Street 1:5465 ASPEN MEADOW LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GREEN
Practice Address - State:UT
Practice Address - Zip Code:84050-6766
Practice Address - Country:US
Practice Address - Phone:801-540-0115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty