Healthcare Provider Details

I. General information

NPI: 1609112259
Provider Name (Legal Business Name): SOMNIUM SLEEP SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 44TH AVE S STE B
GRAND FORKS ND
58201-3434
US

IV. Provider business mailing address

1451 44TH AVE S STE B
GRAND FORKS ND
58201-3434
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-2642
  • Fax:
Mailing address:
  • Phone: 701-732-2642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RAVI MAHADEVIA
Title or Position: OWNER
Credential:
Phone: 701-732-2642