Provider Demographics
NPI:1295870871
Name:COASTAL SLEEP DIAGNOSTICS INC.
Entity type:Organization
Organization Name:COASTAL SLEEP DIAGNOSTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRENDA
Authorized Official - Suffix:
Authorized Official - Credentials:CRT, CRT-SDS
Authorized Official - Phone:781-740-9155
Mailing Address - Street 1:6 BLACKSTONE VALLEY PL STE 707
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1170
Mailing Address - Country:US
Mailing Address - Phone:401-286-9201
Mailing Address - Fax:781-740-9156
Practice Address - Street 1:76 AIRLINE RD STE D
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-2583
Practice Address - Country:US
Practice Address - Phone:781-740-9155
Practice Address - Fax:781-740-9156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPOCH SLEEP CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332BX2000X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6275830001Medicare NSC