Healthcare Provider Details

I. General information

NPI: 1861840431
Provider Name (Legal Business Name): ROSEWOOD SLEEP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W VINE ST SUITE A
TOOELE UT
84074-2083
US

IV. Provider business mailing address

181 W VINE ST SUITE A
TOOELE UT
84074-2083
US

V. Phone/Fax

Practice location:
  • Phone: 435-841-9321
  • Fax: 435-882-1040
Mailing address:
  • Phone: 435-841-9321
  • Fax: 435-882-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5672092
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number5672092
License Number StateUT

VIII. Authorized Official

Name: DR. LANDON BRET ROCKWELL
Title or Position: REGISTERED AGENT (OWNER)
Credential: D.D.S.
Phone: 435-840-0698