Healthcare Provider Details

I. General information

NPI: 1386209625
Provider Name (Legal Business Name): NORTH COAST SLEEP SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 ABBE RD N STE E
ELYRIA OH
44035-1600
US

IV. Provider business mailing address

1212 ABBE RD N STE E
ELYRIA OH
44035-1600
US

V. Phone/Fax

Practice location:
  • Phone: 440-366-2441
  • Fax: 440-366-6311
Mailing address:
  • Phone: 440-366-2441
  • Fax: 440-366-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PAUL J MINNILLO JR.
Title or Position: OWNER
Credential: DDS
Phone: 440-452-5144