Provider Demographics
NPI:1922138197
Name:PDX SLEEP SOLUTIONS, LLC
Entity Type:Organization
Organization Name:PDX SLEEP SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAVIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-863-0490
Mailing Address - Street 1:10808 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3889
Mailing Address - Country:US
Mailing Address - Phone:909-481-2577
Mailing Address - Fax:
Practice Address - Street 1:12901 SE 97TH AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-7901
Practice Address - Country:US
Practice Address - Phone:503-652-0067
Practice Address - Fax:503-652-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies