Organization
ILLINOIS SLEEP PROVIDER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEJANDRA DURAN (CFO)
(708) 442-9800
Entity
Organization
Contact information
Practice address
8736 OGDEN AVE, LYONS, IL 60534-1060
(708) 442-9800
(708) 442-9889
Mailing address
8736 W ODGEN AVE, LYONS, IL 60534-1060
(708) 442-9800
(708) 442-9889
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
203.000618
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633937
BCBS PROVIDER NUMBER
IL
01
—
194.003094
STATE OF ILL. LICENSE
IL
01
—
203.000618
STATE OF ILLINOIS LICENSE
IL
Enumeration date
06/20/2006
Last updated
01/27/2014
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