Healthcare Provider Details

I. General information

NPI: 1437867132
Provider Name (Legal Business Name): AWAKE LABS US CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N BROAD STREET SUITE 5, #847
MIDDLETOWN DE
19709
US

IV. Provider business mailing address

8 THE GRN STE 12893
DOVER DE
19901-3618
US

V. Phone/Fax

Practice location:
  • Phone: 651-353-4404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CARA MELVIN
Title or Position: SR. DIRECTOR OF PARTNER RELATIONS
Credential: LISW
Phone: 651-468-4795