Healthcare Provider Details

I. General information

NPI: 1891940250
Provider Name (Legal Business Name): IN-HOME SLEEP DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16595 COYOTE DR
SPRINGVILLE CA
93265-9342
US

IV. Provider business mailing address

16595 COYOTE DR
SPRINGVILLE CA
93265-9342
US

V. Phone/Fax

Practice location:
  • Phone: 559-719-0436
  • Fax: 559-539-3161
Mailing address:
  • Phone: 559-719-0436
  • Fax: 559-539-3161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK J BODOH
Title or Position: GEN PARTNER
Credential:
Phone: 559-719-0436