Healthcare Provider Details

I. General information

NPI: 1053936484
Provider Name (Legal Business Name): MISHAWAKA SLEEP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E DAY RD STE 150
MISHAWAKA IN
46545-3463
US

IV. Provider business mailing address

230 E DAY RD STE 150
MISHAWAKA IN
46545-3463
US

V. Phone/Fax

Practice location:
  • Phone: 574-800-5080
  • Fax:
Mailing address:
  • Phone: 574-800-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MORGAN STEELY
Title or Position: PRESIDENT / OWNER
Credential: DDS
Phone: 574-800-5080