Provider Demographics
NPI:1902859366
Name:SLEEP WAKE CENTER
Entity Type:Organization
Organization Name:SLEEP WAKE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:CANELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-554-4084
Mailing Address - Street 1:7217 INDIANAPOLIS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324
Mailing Address - Country:US
Mailing Address - Phone:219-554-4084
Mailing Address - Fax:219-554-4089
Practice Address - Street 1:7217 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2213
Practice Address - Country:US
Practice Address - Phone:219-554-4084
Practice Address - Fax:219-554-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN003720-35261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200804000AMedicaid
IN234740Medicare PIN