Provider Demographics
NPI:1699051599
Name:HAAGA MATTRESS
Entity type:Organization
Organization Name:HAAGA MATTRESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANESE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-485-1025
Mailing Address - Street 1:307 E 2100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2235
Mailing Address - Country:US
Mailing Address - Phone:801-485-1025
Mailing Address - Fax:801-410-4086
Practice Address - Street 1:307 E 2100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2235
Practice Address - Country:US
Practice Address - Phone:801-485-1025
Practice Address - Fax:801-410-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site