Healthcare Provider Details

I. General information

NPI: 1184796773
Provider Name (Legal Business Name): WAKESLEEP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DURALEIGH RD SUITE 302
RALEIGH NC
27612-8106
US

IV. Provider business mailing address

3100 DURALEIGH RD SUITE 302
RALEIGH NC
27612-8106
US

V. Phone/Fax

Practice location:
  • Phone: 919-645-9280
  • Fax: 919-208-2149
Mailing address:
  • Phone: 919-645-9280
  • Fax: 919-208-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLA GRACH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 919-645-9280