Provider Demographics
NPI:1952538803
Name:RES - HEALTH SLEEP CARE CENTER OF RIVER FOREST, LLC
Entity Type:Organization
Organization Name:RES - HEALTH SLEEP CARE CENTER OF RIVER FOREST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-652-7900
Mailing Address - Street 1:1300 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4526
Mailing Address - Country:US
Mailing Address - Phone:630-652-7900
Mailing Address - Fax:630-652-7999
Practice Address - Street 1:7411 LAKE ST
Practice Address - Street 2:SUITE L-110
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1876
Practice Address - Country:US
Practice Address - Phone:630-652-7900
Practice Address - Fax:630-652-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
P00887952Medicare PIN