=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730719535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUST SLEEP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2020
-----------------------------------------------------
Last Update Date | 01/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 416F ROBERTSON BLVD
-----------------------------------------------------
City | WALTERBORO
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29488-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-331-5772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 803 HOPE RD
-----------------------------------------------------
City | BRANCHVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29432-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-331-5772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. STEVEN GLEN SULLIVAN
-----------------------------------------------------
Credential | RT, RPSGT
-----------------------------------------------------
Telephone | 803-331-5772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------