Healthcare Provider Details

I. General information

NPI: 1437622008
Provider Name (Legal Business Name): EXCEPTIONAL SLEEP COLORADO SPRINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10807 NEW ALLEGIANCE DR STE 465
COLORADO SPRINGS CO
80921-3722
US

IV. Provider business mailing address

10807 NEW ALLEGIANCE DR STE 465
COLORADO SPRINGS CO
80921-3722
US

V. Phone/Fax

Practice location:
  • Phone: 719-548-9393
  • Fax: 719-548-9313
Mailing address:
  • Phone: 719-548-9393
  • Fax: 719-548-9313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: GREGORY M SOLICH
Title or Position: OWNER
Credential:
Phone: 719-548-9393