Healthcare Provider Details

I. General information

NPI: 1528247301
Provider Name (Legal Business Name): THE SLEEP WELLNESS INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S 102ND ST STE 102
WEST ALLIS WI
53227-2132
US

IV. Provider business mailing address

2400 S 102ND ST STE 102
WEST ALLIS WI
53227-2132
US

V. Phone/Fax

Practice location:
  • Phone: 414-336-3000
  • Fax: 414-336-1015
Mailing address:
  • Phone: 414-336-3000
  • Fax: 414-336-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. VERNON R BAAKE
Title or Position: CEO
Credential:
Phone: 414-336-3000