Provider Demographics
NPI:1811204944
Name:SLEEP SERVICES OF WISCONSIN, LLC
Entity Type:Organization
Organization Name:SLEEP SERVICES OF WISCONSIN, LLC
Other - Org Name:THE SLEEP WELLNES INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-336-3000
Mailing Address - Street 1:2356 S 102ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2104
Mailing Address - Country:US
Mailing Address - Phone:414-336-3000
Mailing Address - Fax:414-336-1015
Practice Address - Street 1:11725 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 225
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3485
Practice Address - Country:US
Practice Address - Phone:262-241-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic