MEDICARE: GREEN REST MATTRESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1679257778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN REST MATTRESS LLC

Provider Business Mailing Address
First Line	:	3750 W COLONIAL DR UNIT 2
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-7906
Country	:	US
Telephone Number	:	407-480-2175
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 W COLONIAL DR UNIT 2
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-7906
Country	:	US
Telephone Number	:	407-480-2175
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ROSILENE CUSTODIO GONCALVES
Credential	:
Telephone Number	:	407-509-0427

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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Directions to “GREEN REST MATTRESS LLC ” Practice Location

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