Provider Demographics
NPI:1952849499
Name:EZ SLEEP CLUB, INC.
Entity Type:Organization
Organization Name:EZ SLEEP CLUB, INC.
Other - Org Name:MODESTO SLEEP CENTER DIAGNOSTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EWERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-523-0202
Mailing Address - Street 1:PO BOX 578104
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-8104
Mailing Address - Country:US
Mailing Address - Phone:888-588-0202
Mailing Address - Fax:888-599-0202
Practice Address - Street 1:5039 PENTECOST DR STE D
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9290
Practice Address - Country:US
Practice Address - Phone:888-588-0202
Practice Address - Fax:888-599-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-04
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic