Provider Demographics
NPI:1245492172
Name:HOME SLEEP LAB LLC
Entity type:Organization
Organization Name:HOME SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-497-5089
Mailing Address - Street 1:1583 HAWK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1274
Mailing Address - Country:US
Mailing Address - Phone:760-497-5089
Mailing Address - Fax:
Practice Address - Street 1:1583 HAWK VIEW DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1274
Practice Address - Country:US
Practice Address - Phone:760-497-5089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No293D00000XLaboratoriesPhysiological Laboratory