Healthcare Provider Details

I. General information

NPI: 1790350643
Provider Name (Legal Business Name): ELITE SLEEP SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 GOLF COURSE DR STE 105
BAXTER MN
56425-8617
US

IV. Provider business mailing address

14410 GOLF COURSE DR STE 105
BAXTER MN
56425-8617
US

V. Phone/Fax

Practice location:
  • Phone: 218-820-6195
  • Fax:
Mailing address:
  • Phone: 218-454-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KIRSTEN SMITH
Title or Position: CEO
Credential: RCP, RT
Phone: 218-454-2064