Provider Demographics
NPI:1780056382
Name:RESPITE SLEEP DIAGNOSTIC CENTER AT THE NEUROLIFE CONSORTIUM LLC
Entity type:Organization
Organization Name:RESPITE SLEEP DIAGNOSTIC CENTER AT THE NEUROLIFE CONSORTIUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-768-0703
Mailing Address - Street 1:3117 COLLEGE PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4192
Mailing Address - Country:US
Mailing Address - Phone:281-319-4910
Mailing Address - Fax:
Practice Address - Street 1:3117 COLLEGE PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4192
Practice Address - Country:US
Practice Address - Phone:281-319-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Multi-Specialty