1831115112 NPI number — BEST REST SLEEP CENTERS INC

Table of content: (NPI 1831115112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831115112 NPI number — BEST REST SLEEP CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEST REST SLEEP CENTERS 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:
Provider Other Organization Name Type Code:
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:
1831115112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32239-1165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-858-1909
Provider Business Mailing Address Fax Number:
904-858-1911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 PRUDENTIAL DR
Provider Second Line Business Practice Location Address:
SUITE 1001
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-8133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-858-1909
Provider Business Practice Location Address Fax Number:
904-858-1911
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTOPHERSON
Authorized Official First Name:
RICH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
904-858-1909

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  HCC6849 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: V2990 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 302003 . This is a "AVMED ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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