Healthcare Provider Details

I. General information

NPI: 1952951675
Provider Name (Legal Business Name): SWSLEEP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2019
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BUTLER AVE, STE 105
FARMINGTON NM
87401-6867
US

IV. Provider business mailing address

3401 N BUTLER AVE STE 105
FARMINGTON NM
87401-6867
US

V. Phone/Fax

Practice location:
  • Phone: 505-787-2184
  • Fax: 505-436-2991
Mailing address:
  • Phone: 505-787-2184
  • Fax: 505-436-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN C EBERHART
Title or Position: OWNER
Credential: RRT-SDS, RPSGT
Phone: 949-874-5932