Provider Demographics
NPI:1750553350
Name:WHITE MOUNTAIN SLEEP LAB, INC
Entity type:Organization
Organization Name:WHITE MOUNTAIN SLEEP LAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-368-3965
Mailing Address - Street 1:1792 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5392
Mailing Address - Country:US
Mailing Address - Phone:928-368-3965
Mailing Address - Fax:928-358-4601
Practice Address - Street 1:1792 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5392
Practice Address - Country:US
Practice Address - Phone:928-368-3965
Practice Address - Fax:928-358-4601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE MOUNTAIN SLEEP LAB, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-24
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic