Healthcare Provider Details

I. General information

NPI: 1750961744
Provider Name (Legal Business Name): SIMPLY SLEEP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W FAIRMONT PKWY STE F
LA PORTE TX
77571-6314
US

IV. Provider business mailing address

401 W FAIRMONT PKWY STE F
LA PORTE TX
77571-6314
US

V. Phone/Fax

Practice location:
  • Phone: 346-443-2389
  • Fax: 346-443-2398
Mailing address:
  • Phone: 346-443-2389
  • Fax: 346-443-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELSEY NANCARROW
Title or Position: OWNER
Credential: RPSGT, RST, CCSH
Phone: 832-202-8499