Provider Demographics
NPI:1922264209
Name:AT HOME SLEEP STUDIES LLC
Entity Type:Organization
Organization Name:AT HOME SLEEP STUDIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEARBY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAILLARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-463-8062
Mailing Address - Street 1:1661 E FLAMINGO RD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5291
Mailing Address - Country:US
Mailing Address - Phone:702-463-8062
Mailing Address - Fax:702-463-8368
Practice Address - Street 1:1661 E FLAMINGO RD
Practice Address - Street 2:SUITE 4B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5291
Practice Address - Country:US
Practice Address - Phone:702-463-8062
Practice Address - Fax:702-463-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1200X
NV2000154-426302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1922264209Medicaid
NVDX772AMedicare UPIN