Provider Demographics
NPI:1689232134
Name:SUPERSOMNIA LLC
Entity Type:Organization
Organization Name:SUPERSOMNIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHIVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-216-5068
Mailing Address - Street 1:6886 CASCADE RD SE STE D
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6879
Mailing Address - Country:US
Mailing Address - Phone:616-216-5068
Mailing Address - Fax:
Practice Address - Street 1:6886 CASCADE RD SE STE D
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6879
Practice Address - Country:US
Practice Address - Phone:616-216-5068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5306005123OtherSTATE OF MICHIGAN BPL