Provider Demographics
NPI:1962792804
Name:ADVANCED SLEEP HEALTH, LLC
Entity type:Organization
Organization Name:ADVANCED SLEEP HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-263-4666
Mailing Address - Street 1:1409 FRANKLIN ST
Mailing Address - Street 2:SUITE103
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2899
Mailing Address - Country:US
Mailing Address - Phone:360-213-1301
Mailing Address - Fax:360-213-1303
Practice Address - Street 1:1230 MARINE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4059
Practice Address - Country:US
Practice Address - Phone:503-325-8209
Practice Address - Fax:503-325-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
R159378Medicare PIN