Provider Demographics
NPI:1821477027
Name:ADVANCED SLEEP CARE CENTERS OF
Entity Type:Organization
Organization Name:ADVANCED SLEEP CARE CENTERS OF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PRENDERGAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-457-1110
Mailing Address - Street 1:6979 S HOLLY CIR STE 185
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1065
Mailing Address - Country:US
Mailing Address - Phone:720-457-1110
Mailing Address - Fax:303-773-3726
Practice Address - Street 1:6979 S HOLLY CIR STE 185
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1065
Practice Address - Country:US
Practice Address - Phone:720-457-1110
Practice Address - Fax:303-773-3726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATRICK T PRENDERGAST, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-21
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7378930001Medicare NSC