Provider Demographics
NPI:1790929768
Name:BACK2SLEEP,LLC
Entity Type:Organization
Organization Name:BACK2SLEEP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GROTEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-367-3546
Mailing Address - Street 1:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-0694
Mailing Address - Country:US
Mailing Address - Phone:813-367-3546
Mailing Address - Fax:253-799-3853
Practice Address - Street 1:3001 N ROCKY POINT DR E
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5810
Practice Address - Country:US
Practice Address - Phone:813-367-3546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies