Healthcare Provider Details

I. General information

NPI: 1396288742
Provider Name (Legal Business Name): HEAVENLY SLEEP CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S JAMES RD
COLUMBUS OH
43213-1621
US

IV. Provider business mailing address

60 S JAMES RD
COLUMBUS OH
43213-1621
US

V. Phone/Fax

Practice location:
  • Phone: 614-235-5560
  • Fax: 614-235-1857
Mailing address:
  • Phone: 614-235-5560
  • Fax: 614-235-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number017498
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN K WILSON
Title or Position: SOLE MEMBER
Credential: D.D.S.
Phone: 614-235-9552