Provider Demographics
NPI:1730475310
Name:EXCELLENT SLEEP STUDY CENTER, LLC
Entity Type:Organization
Organization Name:EXCELLENT SLEEP STUDY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:J
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-456-0381
Mailing Address - Street 1:14489 JOHN HUMPHREY DR
Mailing Address - Street 2:SUITE 1-SD
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2637
Mailing Address - Country:US
Mailing Address - Phone:708-364-1205
Mailing Address - Fax:
Practice Address - Street 1:14489 JOHN HUMPHREY DR
Practice Address - Street 2:SUITE 1-SD
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2637
Practice Address - Country:US
Practice Address - Phone:708-364-1205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory