Provider Demographics
NPI:1881707891
Name:HOME SLEEP DIAGNOSTICS
Entity type:Organization
Organization Name:HOME SLEEP DIAGNOSTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AHUVA
Authorized Official - Middle Name:ELANA
Authorized Official - Last Name:SHABAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-262-4110
Mailing Address - Street 1:2522 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4109
Mailing Address - Country:US
Mailing Address - Phone:773-262-4110
Mailing Address - Fax:773-784-0701
Practice Address - Street 1:2522 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4109
Practice Address - Country:US
Practice Address - Phone:773-262-4110
Practice Address - Fax:773-784-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001620869OtherBCBS PROVIDER #
IL396250Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER