Healthcare Provider Details

I. General information

NPI: 1295156818
Provider Name (Legal Business Name): SLEEP DESIGNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 NW CIVIC DR
GRESHAM OR
97030-5566
US

IV. Provider business mailing address

1867 NW CIVIC DR
GRESHAM OR
97030-5566
US

V. Phone/Fax

Practice location:
  • Phone: 503-907-0311
  • Fax: 503-661-6596
Mailing address:
  • Phone: 503-907-0311
  • Fax: 503-661-6596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number6534
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. TERRYLYNN TENNANT
Title or Position: OWNER
Credential: DMD
Phone: 503-907-0311