Provider Demographics
NPI:1720497910
Name:BLOOMINGDALE SLEEP THERAPY, INC.
Entity Type:Organization
Organization Name:BLOOMINGDALE SLEEP THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-980-3898
Mailing Address - Street 1:290 SPRINGFIELD DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2214
Mailing Address - Country:US
Mailing Address - Phone:630-980-3880
Mailing Address - Fax:
Practice Address - Street 1:290 SPRINGFIELD DR
Practice Address - Street 2:SUITE 160
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2214
Practice Address - Country:US
Practice Address - Phone:630-980-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-020133332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment