Healthcare Provider Details

I. General information

NPI: 1558585174
Provider Name (Legal Business Name): SLEEP HEALTH & WELLNESS NW GRESHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 E POWELL BLVD
GRESHAM OR
97030-8003
US

IV. Provider business mailing address

2460 NE GRIFFIN OAKS ST SUITE D1000
HILLSBORO OR
97124-2672
US

V. Phone/Fax

Practice location:
  • Phone: 503-465-9414
  • Fax: 503-465-9418
Mailing address:
  • Phone: 503-352-0700
  • Fax: 503-352-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JILL M GLENN
Title or Position: CEO
Credential:
Phone: 503-465-9414