MEDICARE: CAROLINA WREN SLEEP SERVICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	293D00000X	Physiological Laboratory
3	332BX2000X	Oxygen Equipment & Supplies (DME)
4	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1508546656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA WREN SLEEP SERVICE LLC

Provider Business Mailing Address
First Line	:	242 S MAIN ST
Second Line	:
City	:	MULLINS
State	:	SC
Zip	:	29574-3120
Country	:	US
Telephone Number	:	843-289-1574
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 S MAIN ST
Second Line	:
City	:	MULLINS
State	:	SC
Zip	:	29574-3120
Country	:	US
Telephone Number	:	843-289-1574
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CURTIS RUSH
Credential	:	RCP
Telephone Number	:	843-289-1574

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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