Provider Demographics
NPI:1760726277
Name:SLEEP WELLNESS EQUIPMENT & SUPPLIES, LLC
Entity Type:Organization
Organization Name:SLEEP WELLNESS EQUIPMENT & SUPPLIES, LLC
Other - Org Name:SLEEP WELLNESS EQUIPMENT & SUPPLIES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FAKHRE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-549-6378
Mailing Address - Street 1:2731 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1027
Mailing Address - Country:US
Mailing Address - Phone:618-519-9700
Mailing Address - Fax:618-549-9724
Practice Address - Street 1:2731 WEST MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-519-9700
Practice Address - Fax:618-549-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12922Medicare PIN
IL036101704Medicaid
ILG28755Medicare UPIN