Provider Demographics
NPI:1932600459
Name:BOURBONNAIS SLEEP SOLUTIONS LLC
Entity type:Organization
Organization Name:BOURBONNAIS SLEEP SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-937-4455
Mailing Address - Street 1:14 BRIARCLIFF PROFESSIONAL CENTER
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914
Mailing Address - Country:US
Mailing Address - Phone:815-937-4455
Mailing Address - Fax:815-937-5516
Practice Address - Street 1:14 BRIARCLIFF PROFESSIONAL CENTER
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-937-4455
Practice Address - Fax:815-937-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-016353261QD0000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental