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General NPI Number Information
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NPI Number | 1881255784
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Entity Type | Organization
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Legal Business Name | PORTABLE SLEEP SOLUTIONS LLC
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Dates
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Enumeration Date | 06/22/2019
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Last Update Date | 06/22/2019
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Provider Practice Location Address
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Address Line | 820 SW ADAMS ST
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City | PEORIA
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State | IL
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Zip | 61602-1623
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Country | US
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Telephone | 309-822-1046
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Fax |
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Provider Business Mailing Address
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Address Line | 480 TAZEWOOD RD
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City | METAMORA
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State | IL
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Zip | 61548-7302
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Country | US
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Telephone | 309-822-1046
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Fax | 309-210-5247
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Authorized Official
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Title or Position | MANAGER
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Name | LISA COATES
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Credential | CRT, RPSGT
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Telephone | 309-645-0689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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