Provider Demographics
NPI:1790350643
Name:ELITE SLEEP SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ELITE SLEEP SOLUTIONS, LLC
Other - Org Name:ELITE SLEEP SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RCP, RT
Authorized Official - Phone:218-454-2064
Mailing Address - Street 1:14410 GOLF COURSE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8617
Mailing Address - Country:US
Mailing Address - Phone:218-454-2064
Mailing Address - Fax:
Practice Address - Street 1:14410 GOLF COURSE DR STE 105
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8617
Practice Address - Country:US
Practice Address - Phone:218-820-6195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies