Healthcare Provider Details

I. General information

NPI: 1336585959
Provider Name (Legal Business Name): 2ND WIND SLEEP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 SW GREENBURG RD STE. 275
TIGARD OR
97223-5502
US

IV. Provider business mailing address

110 HICKORY ST NW
ALBANY OR
97321-1724
US

V. Phone/Fax

Practice location:
  • Phone: 503-747-6857
  • Fax: 503-747-6891
Mailing address:
  • Phone: 541-981-2837
  • Fax: 541-704-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number93255991
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: LISA RICE
Title or Position: CEO
Credential:
Phone: 541-981-2837