Healthcare Provider Details

I. General information

NPI: 1053659938
Provider Name (Legal Business Name): DEDICATED SLEEP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21260 S SPRINGWATER RD
ESTACADA OR
97023-9650
US

IV. Provider business mailing address

21260 S SPRINGWATER RD
ESTACADA OR
97023-9650
US

V. Phone/Fax

Practice location:
  • Phone: 360-907-7534
  • Fax:
Mailing address:
  • Phone: 360-907-7534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JILL MARIE GLENN
Title or Position: PRESIDENT
Credential:
Phone: 360-907-7534