Healthcare Provider Details

I. General information

NPI: 1700335809
Provider Name (Legal Business Name): GOODNITE SLEEP SOLUTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 ORANGE TREE LN STE 160
REDLANDS CA
92374-4527
US

IV. Provider business mailing address

29030 EASTON LN
HIGHLAND CA
92346-7752
US

V. Phone/Fax

Practice location:
  • Phone: 909-904-3387
  • Fax: 909-614-8080
Mailing address:
  • Phone: 909-904-3387
  • Fax: 909-614-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA N. NICOLAS
Title or Position: CEO
Credential: RESPIRATORY THERAPY
Phone: 909-904-3387