Provider Demographics
NPI:1174801864
Name:SERENITY SLEEP LAB LLC
Entity type:Organization
Organization Name:SERENITY SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:LUDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-932-0048
Mailing Address - Street 1:2304 E BIDWELL ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3455
Mailing Address - Country:US
Mailing Address - Phone:916-932-0048
Mailing Address - Fax:916-932-0049
Practice Address - Street 1:2304 E BIDWELL ST STE 110
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3455
Practice Address - Country:US
Practice Address - Phone:916-932-0048
Practice Address - Fax:916-932-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic