MEDICARE: RENUYOU SLEEP AND WELLNESS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1992341432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENUYOU SLEEP AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	12807 DADEBROOK CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-7306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W FAIRMONT PKWY STE F
Second Line	:
City	:	LA PORTE
State	:	TX
Zip	:	77571-6314
Country	:	US
Telephone Number	:	800-771-9138
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL EXECUTIVE
Name	:	MRS. BETH SIDNEY
Credential	:
Telephone Number	:	619-752-2234

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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