Provider Demographics
NPI:1770734204
Name:KENTUCKY SLEEP LAB LLC
Entity type:Organization
Organization Name:KENTUCKY SLEEP LAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-565-4483
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-0393
Mailing Address - Country:US
Mailing Address - Phone:502-222-0330
Mailing Address - Fax:502-222-0390
Practice Address - Street 1:1006 NEW MOODY LN FL 2
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9122
Practice Address - Country:US
Practice Address - Phone:502-222-0330
Practice Address - Fax:502-222-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary DiagnosticsGroup - Single Specialty