MEDICARE: SLEEPWELL LABRATORIES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1770580821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEPWELL LABRATORIES, INC

Provider Business Mailing Address
First Line	:	17555 VENTURA BLVD
Second Line	:	STE 201
City	:	ENCINO
State	:	CA
Zip	:	91316-3836
Country	:	US
Telephone Number	:	818-933-5269
Fax Number	:	818-933-5274

Provider Business Practice Location Address
First Line	:	12727 SOUTHWEST FWY
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-3806
Country	:	US
Telephone Number	:	281-980-1430
Fax Number	:	281-980-1436

Authorized Official
Title or Position	:	VP CLINICAL OPERATIONS
Name	:	CONSTANCE BAKER
Credential	:
Telephone Number	:	480-516-8471

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/22/2020

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