Provider Demographics
NPI:1013167774
Name:BACK2SLEEP, LLC
Entity Type:Organization
Organization Name:BACK2SLEEP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GROTEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-377-5416
Mailing Address - Street 1:303 MAIN ST UNIT 143
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-9706
Mailing Address - Country:US
Mailing Address - Phone:813-377-5416
Mailing Address - Fax:253-799-3853
Practice Address - Street 1:12875 COMMODITY PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3104
Practice Address - Country:US
Practice Address - Phone:813-377-5416
Practice Address - Fax:253-799-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies