1861731663 NPI number — RELIANCE SLEEP CENTERS OF AMERICA INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861731663 NPI number — RELIANCE SLEEP CENTERS OF AMERICA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIANCE SLEEP CENTERS OF AMERICA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RELIANCE SLEEP CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861731663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
87 LINDSEY LANE
Provider Second Line Business Mailing Address:
UNIT A
Provider Business Mailing Address City Name:
KINGSLAND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31548-6836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-576-6831
Provider Business Mailing Address Fax Number:
912-576-6861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
993 YEOMANS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACKSHEAR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31516-2083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-807-0904
Provider Business Practice Location Address Fax Number:
912-807-0904
Provider Enumeration Date:
02/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHEHEE
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
912-388-4556

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 528406168A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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