Provider Demographics
NPI:1740678630
Name:PHOENIX SLEEP SOLUTIONS, LLC
Entity type:Organization
Organization Name:PHOENIX SLEEP SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:MCDERMAND
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:877-311-6731
Mailing Address - Street 1:2355 FAIRVIEW AVE N
Mailing Address - Street 2:# 123
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2724
Mailing Address - Country:US
Mailing Address - Phone:877-311-6731
Mailing Address - Fax:855-844-8083
Practice Address - Street 1:2355 FAIRVIEW AVE N
Practice Address - Street 2:# 123
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2724
Practice Address - Country:US
Practice Address - Phone:877-311-6731
Practice Address - Fax:855-844-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment