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General NPI Number Information
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NPI Number | 1033491410
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Entity Type | Organization
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Legal Business Name | STATELINE SLEEP SERVICES LTD,.
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 175 CADILLAC CT STE 2
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City | BELVIDERE
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State | IL
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Zip | 61008-1729
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Country | US
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Telephone | 815-547-5715
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Fax | 815-547-5715
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Provider Business Mailing Address
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Address Line | 175 CADILLAC CT STE 2
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City | BELVIDERE
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State | IL
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Zip | 61008-1729
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RAYMOND HOWARD GAMBLE
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Credential | RPSGT
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Telephone | 815-547-5715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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