Healthcare Provider Details

I. General information

NPI: 1598762106
Provider Name (Legal Business Name): TOLLGATE SLEEP DISORDERS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD SUITE 529
WARWICK RI
02886-1617
US

IV. Provider business mailing address

400 BALD HILL RD SUITE 529
WARWICK RI
02886-1617
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-4115
  • Fax: 401-737-4347
Mailing address:
  • Phone: 401-737-4115
  • Fax: 401-737-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberRCP00377
License Number StateRI

VIII. Authorized Official

Name: MS. DONNA J HAYDEN
Title or Position: PRESIDENT
Credential: RCP
Phone: 401-737-4115