Provider Demographics
NPI:1912214727
Name:CLASSIC SLEEPCARE, LLC
Entity Type:Organization
Organization Name:CLASSIC SLEEPCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-707-2454
Mailing Address - Street 1:30851 AGOURA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301
Mailing Address - Country:US
Mailing Address - Phone:888-707-2454
Mailing Address - Fax:888-249-3875
Practice Address - Street 1:138 WEST STATE STREET
Practice Address - Street 2:SUITE #4
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064
Practice Address - Country:US
Practice Address - Phone:888-707-2454
Practice Address - Fax:888-249-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE0656112006-5332B00000X
CAE0656112006332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5834640001Medicare NSC