=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578760500
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY FORGE SLEEP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2007
-----------------------------------------------------
Last Update Date | 07/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1208 WOODVIEW WAY
-----------------------------------------------------
City | MALVERN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19355-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-827-1539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 LAUREN LN
-----------------------------------------------------
City | CHESTER SPRINGS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19425-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-827-1539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLER
-----------------------------------------------------
Name | HEIDI NEUBECK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-941-4433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------