=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386185700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD SLEEP HEALTHCARE SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2017
-----------------------------------------------------
Last Update Date | 01/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 FORT WORTH DR STE 211
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76201-7179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-465-3822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 FORT WORTH DR STE 211
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76201-7179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-465-3822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER - CEO
-----------------------------------------------------
Name | MR. PHILLIP MORRIS BIRDINE JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 940-465-3822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1001863
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------