Provider Demographics
NPI:1902195894
Name:NOVASLEEP, LLC
Entity Type:Organization
Organization Name:NOVASLEEP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-484-0000
Mailing Address - Street 1:9475 BRIAR VILLAGE PT
Mailing Address - Street 2:SUITE 320
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7901
Mailing Address - Country:US
Mailing Address - Phone:719-487-0890
Mailing Address - Fax:719-484-0031
Practice Address - Street 1:9475 BRIAR VILLAGE PT
Practice Address - Street 2:SUITE 320
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7901
Practice Address - Country:US
Practice Address - Phone:719-487-0890
Practice Address - Fax:719-484-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB 5166OtherMEDICARE PTAN
CO43628346Medicaid