Provider Demographics
NPI:1700335809
Name:GOODNITE SLEEP SOLUTION, LLC
Entity Type:Organization
Organization Name:GOODNITE SLEEP SOLUTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:NICOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:RESPIRATORY THERAPY
Authorized Official - Phone:909-904-3387
Mailing Address - Street 1:29030 EASTON LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-7752
Mailing Address - Country:US
Mailing Address - Phone:909-904-3387
Mailing Address - Fax:909-614-8080
Practice Address - Street 1:1902 ORANGE TREE LN STE 160
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4527
Practice Address - Country:US
Practice Address - Phone:909-904-3387
Practice Address - Fax:909-614-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic