Provider Demographics
NPI:1902653389
Name:ISLAND DREAM SLEEP CENTER, LLC
Entity Type:Organization
Organization Name:ISLAND DREAM SLEEP CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:901-848-8736
Mailing Address - Street 1:4100 SION FARM SHOPP CTR STE 8
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4433
Mailing Address - Country:US
Mailing Address - Phone:340-208-9736
Mailing Address - Fax:901-742-2552
Practice Address - Street 1:4100 SION FARM SHOPP CTR STE 8
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4433
Practice Address - Country:US
Practice Address - Phone:340-208-9736
Practice Address - Fax:901-742-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic